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LIBRARY 

OF  THE 

UNIVERSITY  OF  CALIFORNIA. 

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Class 


A   STATISTICAL   STUDY 


OF 


INFANT     MORTALITY 


BY 


EDWARD    BUNNELL    PHELPS,  M.A.,  F.S.S. 

it 

Editor,  THE  AMERICAN  UNDERWRITER,  of  New  York  City 


Reprinted  from  the  Quarterly  Publications  of  the  American  Statistical  Association 
New  Series,  No.  83  (Vol.  XI.),  September,  1908 


^-THE 


o 


A   STATISTICAL   STUDY 


OF 


INFANT     MORTALITY 


Considerably  more  than  a  generation  ago  (in  1865),  Dr.  Farr 
brought  the  subject  of  Infant  Mortality  before  the  [Royal] 
Statistical  Society,  and  frequently  discussed  it  in  his  historic 
contributions  to  the  annual  reports  of  the  Registrar-General's 
office.  On  December  19,  1893,  Dr.  Hugh  R.  Jones  read  before 
the  Royal  Statistical  Society  an  exhaustive  paper  on  "The 
Perils  and  Protection  of  Infant  Life,"  which  had  the  distinction 
of  being  the  Howard  Medal  Prize  Essay  of  that  year.  In  the 
interim  of  more  than  forty  years  since  Dr.  Farr  inaugurated  the 
statistical  discussion,  so  to  speak,  infant  mortality  has  been  a 
prolific  subject  in  medical  works  and  journals,  has  received 
perennial  treatment  in  the  reports  of  practically  all  bureaus  of 
vital  statistics,  and  the  bibliography  of  the  subject  even  up  to 
ten  years  ago  would  constitute  quite  an  impressive  library, 
were  all  the  papers  on,  and  extended  references  to,  this  partic- 
ular phase  of  human  mortality  assembled  and  properly  indexed. 

In  a  general  way,  however,  it  may  be  said  that  only  within  the 
last  few  years  has  the  topic  been  presented  in  such  a  light  as 
to  attract  serious  attention  at  the  hands  of  the  public  at  large, 
the  discussion  up  to  the  end  of  the  nineteenth  century  having 
practically  been  restricted  to  medical  men,  government  officials, 
and  professional  statisticians.  To  be  sure,  as  early  as  1876  a 
Society  for  Nursing  Mothers  was  established  in  France,  and  pro- 


178587 


vision  thus  made  on  a  small  scale  for  caring  for  destitute  mothers 
immediately  before  and  after  childbirth.  The  Creches  of  France 
and  the  Krippen  of  Germany,  or  day  nurseries,  in  part  supported 
by  private  charity  and  in  part  by  State  or  municipal  aid,  long 
since  became  well-known  institutions.  For  many  years  both 
Germany  and  Switzerland  have  had  laws  prohibiting  women 
from  working  in  factories  for  certain  periods  before  and  after 
confinement,  and  providing  for  their  partial  support  during 
those  periods  of  compulsory  idleness;  and  Section  61  of  the 
Factory  and  Workshop  Act  (of  1901)  of  Great  Britain  enjoins 
factory  employers  from  knowingly  allowing  women  to  work  in 
their  factories  within  four  weeks  of  childbirth. 

Furthermore,  some  fifteen  years  ago  Nathan  Straus  began  the 
establishment  of  his  milk  depots  in  New  York  City  with  a  view 
to  supplying  pasteurized  milk  at  nominal  price  for  children's  use, 
and  since  then  the  plan  introduced  by  Mr.  Straus  has  been 
copied  in  various  quarters.  But  all  of  these  institutions  of 
nineteenth-century  origin  were  the  outcomes  of  individual  reali- 
zation of  the  growing  importance  of  the  problem  of  infant 
mortality,  rather  than  of  a  public  appreciation  of  its  far-reaching 
bearing  on  the  future  of  the  race,  and  their  establishment  in  no 
way  controverts  the  previous  statement  that  practically  only 
since  the  dawn  of  the  twentieth  century  has  the  subject  been 
so  brought  forward  as  to  attract  serious  attention  at  the  hands 
of  the  thinking  public. 

The  fact  that  such  an  era  has  now  arrived  is  due  to  a  variety 
of  causes.  In  the  first  place,  even  the  most  pronounced  cynic, 
if  he  be  a  well-informed  and  reasoning  person,  must  admit  that 
the  community  at  large  has  begun  to  take  more  interest  than 
ever  before  in  "how  the  other  half  lives."  So  obvious  and 
indisputable  a  truth  calls  for  no  demonstration,  and  the  grow- 
ing interest  in  "how  the  other  half  dies"  is  an  inevitable  corol- 
lary of  the  ascending  interest  in  how  the  unfortunate  or  less 
fortunate  section  of  the  community  lives.  Perhaps  this  gen- 
eral development  of  the  humanitarian  instinct  is  primarily 
responsible  for  the  civilized  world's  awakening  to  the  appalling 
conditions  of  infant  mortality.  Men  are  beginning  to  realize 


that  the  caste  lines  once  so  rigidly  drawn  between  the  various 
classes  are,  like  most  national  boundaries  in  one  sense  at  least, 
purely  imaginary  lines,  and  that  the  health  and  welfare  of  any 
one  section  of  the  community  directly  concern  the  health  and 
welfare  of  the  community  at  large.  As  Dr.  Margaret  Alden  so 
well  puts  it  in  her  very  recent  work  on  " Child  Life  and  Labour," 
in  the  chapter  on  infant  mortality  (p.  16):  "A  thorough  under- 
standing of  the  subject  should  be  the  concern  of  every  true 
citizen  for  three  reasons:  1.  Because  such  a  wastage  of  human 
life  is  a  loss  of  the  nation's 'best  capital.  2.  Because  the  con- 
ditions whichjiaka_fQr  the  death  of  infants,  make  also  for  dis- 
ease. 3.  Because  this  question  appeals  to  us  on  humanitarian" 
grounds." 

By  way  of  secondary,  indirect,  cause  for  the  general  dawning 
interest  in  the  subject,  probably  the  material  advance  in  medi- 
cal knowledge  and  in  established  principles  of  hygiene  and 
sanitation  has  played  the  most  important  part.  As  an  immedi- 
ate result  of  this  advance  has  come  the  gradual  decrease  in  the 
general  death-rate  of  recent  years  in  practically  all  civilized 
countries,  but  as  Dr.  George  Reid,  Medical  Officer  to  the  Staf- 
fordshire County  Council,  points  out  in  his  contribution  to  the 
cyclopedic  work  on  " Dangerous  Trades"  in  the  paper  on  " In- 
fantile Mortality  and  Factory  Labour"  (pp.  84-85) :  "Although  a 
steady  decline  has  taken  place  in  the  general  mortality  of  the 
country  coincident  with,  and,  no  doubt,  in  the  main,  consequent 
upon  sanitary  progress,  it  cannot  be  said  that  the  infant  mortal- 
ity has  diminished  in  like  proportion."  That  fact  has  been  so 
generally  noted,  and  so  repeatedly  emphasized,  by  both  physi- 
cians and  statisticians,  that  it  could  scarcely  have  failed  to  make 
at  least  some  impression  on  the  public  mind.  And  now  that 
it  has  been  so  graphically  stated,  as,  for  instance,  in  H.  Llewel- 
lyn Heath's  recent  book  on  "The  Infant,  the  Parent,  and  the 
State,"  small  wonder  is  it  that  thoughtful  people  of  all  classes 
are  beginning  to  realize  that  it  is  high  time  some  united  action 
were  taken  with  a  view  to  devising  remedies  for  so  anomalous 
a  situation. 

Mr.  Heath's  indirect  indictment  of  the  previous  apathy  on 


the  subject,  on  the  first  page  of  his  book,  is  put  in  this  blunt 
way:  "In  the  year  1904,  England  lost  137,392  of  her  children 
before  they  had  reached  the  short  span  of  twelve  months  of  life. 
The  deaths  of  these  infants  constituted  25  per  cent,  of  all  the 
deaths  in  England  and  Wales  during  the  year  we  are  consider- 
ing. Geneva  has  kept  registers  of  births,  marriages,  and  deaths 
since  1549.  In  the  sixteenth  century  their  infant  deaths  con- 
stituted 25.9  per  cent,  of  their  total  deaths  at  all  ages."  In 
other  words,  as  Mr.  Heath  thus  makes  clear,  despite  all  the 
hygienic  and  sanitary  progress  of  modern  times,  and  despite  the 
marked  decline  in  the  general  death-rate,  the  ratio  of  infant 
mortality  to  total  mortality  remains  practically  the  same  in 
England  and  Wales  to-day  as  it  was  in  Geneva  nearly  three 
hundred  and  fifty  years  ago;  and,  it  might  be  added,  present 
conditions  in  the  United  States  are  only  slightly  better,  the 
ratio  of  infant  deaths  to  deaths  at  all  ages  in  the  registration 
States  of  this  country  in  the  last  census  year,  as  is  shown  in  one 
of  the  tables  accompanying  this  paper,  having  been  no  less  than 
20.06  per  cent,  as  compared  with  Geneva's  percentage  of  25.9 
more  than  three  centuries  ago. 

The  general  tendencies  in  the  direction  of  an  increased  public 
interest  in  the  subject  of  infant  mortality,  above  briefly  outlined, 
of  course  have  been  materially  supplemented  and  intelligently 
directed  by  the  more  or  less  frequent  contributions  to  the  discus- 
sion of  Dr.  Farr,  Dr.  Bertillon,  Dr.  Newsholme,  Sir  John  Simon, 
Dr.  Greenhow,  Dr.  Reid,  Dr.  Newman,  and  other  statisticians 
and  physicians;  and  so  it  happens  that  in  the  last  three  years 
no  less  than  five  congresses  have  been  held  in  various  European 
countries  with  a  view  to  grappling  seriously  with  the  problems 
of  infant  mortality.  The  first  of  the  five  in  question  was  an 
International  Congress  on  the  Functions  of  Infants'  Milk 
Depots,  which  was  held  in  Paris  in  October,  1905.  The  mayor 
of  Huddersfield,  the  chairman  of  the  Health  Committee  of 
Glasgow,  and  various  other  representatives  from  Great  Britain 
attended  the  congress,  and  as  the  immediate  result  of  their 
attendance  a  National  Conference  on  Infantile  Mortality  was 
held  at  Westminster,  on  June  13-14,  1906.  A  complete  steno- 


graphic  report  of  the  proceedings  of  that  conference  has  been 
published  (London,  1906),  and  the  demand  for  copies  from  all 
parts  of  the  world  was  so  unexpectedly  large  that  the  first  edition 
of  3,000  copies  was  speedily  exhausted,  and  a  second  edition 
made  necessary. 

In  the  preface  to  the  second  edition  the  Executive  Commit- 
tee thus  summarizes  the  former  apathy  and  the  present  general 
interest  in  infant  mortality  above  alluded  to:  "The  Conference 
of  1906  was  the  first  attempt  to  bring  before  the  public  one  of 
the  most  important  of  the  many  aspects  of  the  social  problem 
of  physical  and  social  degeneration.  Prior  to  the  Conference 
the  problem  of  the  appalling  death-rate  of  infants  under  one 
year  attracted  only  the  attention  of  medical  men — and  merely 
a  small  proportion  of  that  profession — and  of  a  few  philan- 
thropists and  social  reformers,  and  the  Executive  Committee, 
who  organized  the  Conference  of  1906,  hardly  ventured  to  hope 
that  their  efforts  would  result  in  one  of  the  most  successful 
conferences,  from  a  public  health  and  social  reform  point  of  view, 
which  has  been  held  in  this  country."  The  conference  was 
held  in  the  rooms  of  the  Westminster  City  Council,  under 
the  patronage  of  their  Majesties  King  Edward  VII.  and  Queen 
Alexandra.  The  Right  Hon.  John  Burns,  M.P.,  president  of  the 
Local  Government  Board,  presided;  and  the  chairman  and  vice- 
chairman,  respectively,  were  Alderman  Evan  Spicer,  M.P., 
chairman  of  the  London  County  Council,  and  the  Hon.  Lord 
Provost  of  Glasgow,  William  Bilsland,  Esq.  The  Lord  Mayors 
of  Liverpool,  Manchester,  Leeds,  York,  and  Belfast,  the  Lord 
Provosts  of  Glasgow,  Edinburgh,  and  Aberdeen,  various  other 
governmental  officials,  and  some  of  the  foremost  medical 
officials  of  Great  Britain  served  as  vice-presidents  of  the  con- 
ference, and  the  enlistment  of  these  notables  gave  a  decided 
impetus  to  the  new  movement.  A  second  National  Con- 
ference on  Infantile  Mortality,  with  an  even  more  distinguished 
list  of  vice-presidents  and  delegates,  was  held  at  Westminster, 
March  23,  24,  25,  1908,  and,  largely  as  a  result  of  the  previous 
conference,  the  Notification  of  Births  Act  of  1907  was  adopted 
by  Parliament.  A  complete  report  of  the  proceedings  and 


6 

papers  of  the  second  conference  was  also  published  (London, 
1908). 

Practically  simultaneous  with  the  first  National  Conference 
at  Westminster,  an  exposition  was  held  at  Berlin  for  the  pur- 
pose of  inaugurating  a  comprehensive  study  of  all  the  various 
phases  of  the  infant  mortality  problem,  and  some  idea  of  the 
scope  of  its  work  may  be  gained  from  the  mere  announcement 
that  the  exposition  was  continued  for  nearly  three  weeks.  In 
its  issue  of  Oct.  13,  1906,  Charities  and  the  Commons  presents 
a  summary  of  the  work  of  the  exposition,  in  part  as  follows: 
"Accompanying  the  exhibits  were  exhaustive  explanatory 
leaflets  and  monographs  by  the  most  celebrated  specialists,  and 
a  catalogue  containing  every  possible  and  minute  detail  to 
instruct  and  enlighten.  A  bare  outline  even  of  the  rich  mass  of 
material  presented  would  go  far  beyond  the  limits  of  our  space, 
and  give  subjects  for  numbers  of  articles.  The  striking  feature 
of  the  exhibit  is  the  increasing  solicitude  of  governments  to 
concern  themselves  in  questions  affecting  the  well-being  and 
happiness  of  people,  and  the  rapidly  increasing  co-ordination 
between  private,  or  voluntary,  and  civic  and  national,  or  au- 
thoritative, reforms.  The  conditions  of  infant  mortality  in 
the  German  Empire  have  for  a  long  time  and  with  reason  been 
the  cause  of  grave  anxiety  to  German  social  and  political  scien- 
tists, since  statistics  have  been  showing  that,  of  the  2,000,000 
infants  born  annually,  400,000,  or  one-fifth,  do  not  survive 
the  first  year  of  existence.  This  disquieting  fact  has  given  rise 
to  the  founding  of  an  institute,  where,  as  a  central  point  for  the 
whole  empire,  the  subject  of  infant  mortality,  its  direct  and 
accessory  causes,  will  be  studied  with  a  seriousness  worthy  of  the 
subject,  and  with  all  the  co-ordinated  thoroughness  and  science 
known  to  the  German  municipality  and  the  German  medical 
profession.  From  the  side  of  medicine  is  to  be  given  the  fullest 
inquiry  into  physiological,  and  from  the  municipality  into  social, 
contributing  causes." 

In  September,  1907,  an  international  conference  on  the  sub- 
ject was  held  at  Brussels,  under  the  name  of  the  Second  Inter- 
national Congress  of  Gouttes  de  Lait,  and  it  was  decided  that 


its  scope  should  be  extended,  and  that  the  next  congress  should 
be  termed  the  International  Congress  for  the  Protection  of 
Infant  Life.  Were  any  further  evidence  of  the  increasing 
interest  in  the  subject  necessary,  it  possibly  might  be  supplied 
by  citing  the  fact  that  the  subject  selected  by  the  Council  of 
the  Royal  Statistical  Society  for  essays  in  competition  for 
the  Howard  Medal  in  1908-09  is:  "A  Statistical  Study  of  In- 
fantile Mortality  in  Great  Britain  and  Ireland,  and  of  its 
Causes." 

Even  this  brief  summation  of  recent  movements — move- 
ments international,  governmental,  and  statistical — in  the 
direction  of  trying  to  discover  some  means  of  coping  with  the 
substantially  stable  death-rate  among  young  children  the 
world  around,  makes  it  evident,  it  seems  to  the  writer,  that  the 
subject  of  infant  mortality  has  at  last  begun  to  impress  its 
importance  upon  the  thinking  element  of  the  civilized  world, 
and  will  unquestionably  receive  more  and  more  attention  in 
the  next  few  years.  In  view  of  that  fact  a  review  of  the  sub- 
ject from  an  up-to-date  statistical  stand-point  may  not  be  inop- 
portune. As  above  noted,  the  compilation  of  vital  statistics 
in  Geneva  dates  back  to  1549,  and  it  might  almost  be  said  that 
from  that  time  down  to  date  there  have  been  more  or  less  com- 
plete compilations  of  the  statistics  of  infant  mortality.  In 
England  local  statistics  on  those  lines  are  practically  co-ex- 
istent with  the  Registrar-General's  office,  the  Massachusetts 
statistics  of  infant  mortality  for  an  even  half-century  are  pre- 
sented in  a  table  accompanying  this  paper,  and  about  eighteen 
years  ago  Dr.  Jacques  Bertillon  prepared  for  the  Encyclo- 
pedic d'Hygiene  et  de  Medecine  Publique  a  compilation  of 
infant  mortality  statistics  for  the  various  countries  of  Europe, 
dating  back  as  far  as  1862  in  one  case. 

The  annual  reports  of  the  Registrar-General's  office  contain 
abstracts  of  the  infant  mortality  rates  of  all  the  leading  coun- 
tries of  the  world,  substantially  down  to  date,  and  Dr.  George 
Newman's  recent  work  on  "  Infant  Mortality — A  Social  Prob- 
lem," contains  a  mass  of  statistical  information  reprinted  from 
various  sources.  The  Tenth,  Eleventh,  and  Twelfth  Census 


8 

Reports,  and  the  three  subsequent  Special  Reports  of  the 
Census  Office  inaugurating  the  prospective  annual  reports  of 
mortality  statistics  of  this  country,  present  a  great  array  of 
information — such  as  it  is — regarding  deaths  of  children  under 
the  ages  of  1  and  5  in  the  United  States,  and  the  reports  of  all 
the  countries  and  States  having  bureaus  of  vital  statistics  also 
contain  more  or  less  data  along  these  lines.  Consequently, 
there  has  been  no  lack  of  infant  mortality  statistics  for  the 
last  fifty  years  and  more,  but,  so  far  as  the  writer  is  aware, 
there  has  been  no  previous  accumulation  of  this  widely  scattered 
information  in  such  a  way  as  to  permit  of  any  reasonably 
accurate,  up-to-date,  international  comparisons  of  the  mortality 
among  infants.  As  subsequently  noted,  the  statistics  of  the 
United  States  at  large  are  wofully  defective,  and  in  the  case  of 
nearly  all  the  registration  States  the  margin  of  error  is  unques- 
tionably a  wide  one,  but  by  means  of  various  methods  of  com- 
parison an  effort  has  been  made  to  reduce  the  statistics  of  this 
country  to  a  fairly  accurate  basis,  and  it  is  hoped  that  a  work- 
able plan  of  contrasting  the  infant  mortality  rates  of  the  United 
States  and  other  countries  has  been  found.  Unless  otherwise 
specified,  the  term  "  infant  mortality  rate,"  wherever  used  in 
this  paper,  is  to  be  construed  as  invariably  referring  to  the  rate 
of  deaths  under  1  year  per  1,000  births — still-births  excluded. 

The  table  of  Dr.  Bertillon,  above  mentioned,  is  generally 
recognized  as  the  earliest  fairly  accurate  summary  of  the  infant 
death-rate  in  Europe,  and  perhaps  may  best  serve  as  the  start- 
ing-point of  this  statistical  review  of  the  subject.  Under  the 
heading  of  "Tableau  LXXXIII,  Mortalite  de  0  a  5  ans  dans 
les  principaux  pays  de  FEurope,"  it  appears  in  Bertillon's 
chapter  on  "Demographic"  in  the  Encyclopedic  d'Hygiene 
(vol.  i,  p.  254),  and,  rearranged  so  as  to  present  the  various 
European  countries  in  the  order  of  their  several  death-rates 
under  age  1,  is  as  herewith  reproduced.  In  its  original  form 
the  table  presents  the  supposed  figures  of  the  late  70's  for 
Massachusetts,  Rhode  Island,  and  Vermont,  which  are  omitted 
in  the  appended  transposed  reprint. 


TABLE   I. 


MORTALITY  FROM  0  TO  1  AND  0  TO  5  YEARS  IN  THE  PRINCIPAL  COUNTRIES  or 
EUROPE  PRIOR  TO  1883,  ACCORDING  TO  THE  BERTILLON  TABLE. 


Countries. 


Period  of 
Observation. 


Of  1,000 
Born  Alive, 
Died  under 

1  Year. 


Of  1,000 
Born  Alive, 
Died  under 

5  Years. 


Ireland 1865-83 

Norway 1866-82 

Scotland 1865-81 

Sweden '        1866-82 

Denmark 1870-82 

Greece 1878-82 

Belgium 1867-83 

England  and  Wales 1866-82 

Portugal 1862 

Finland 1878-80 

France       1875-82 

The  Netherlands 1878-81 

Switzerland 1869-80 

Prussia 1874r-82 

Italy 1872-83 

Alsace-Lorraine 1872-81 

Croatia 1874-82 

Roumania 1875-82 

Austria 1866-83 

Baden 1866-83 

Russia  in  Europe 1867-78 

Saxony      1865-70 

Bavaria 1866-83 

Wiirtemberg 1871-81 


95.9 
104.9 
122.0 
131.9 
137.5 
137.7 
148.2 
149.2 
150.0 
164.9 
166.2 
193.2 
195.2 
207.8 
209.7 
212.7 
234.0 
250.0 
255.3 
261.7 
266.8 
270.0 
308.4 
312.5 


164.6 
179.1 
230.9 
222.5 
204.9 
264.5 
253.2 
249.3 


251.1 

266.3 
316.2 
378.5 
298.0 
423.8 
3396 
389.9 
346.9 
422.9 
373.5 
393.2 
397.1 


The  totals  are  not  given  with  the  tabulation  as  presented 
by  Bertillon,  but,  dividing  the  total  of  4,685.7  deaths  under 
age  1  for  24  countries  and  the  total  of  6,366.0  deaths  under 
age  5  for  21  countries,  it  appears  that  the  averages  for  the 
European  countries  in  the  period  stated  were  195.2  for  deaths 
under  age  1  and  303.1  for  deaths  under  age  5.  In  a  general 
way,  such  were  the  infant  death-rates  of  Europe  a  generation 
ago,  if  the  returns  on  which  Bertillon's  table  was  based  were 
correct.  The  question  which  naturally  follows  a  study  of  them 
is:  How  have  the  infant  death-rates  of  the  intervening  years 
compared  with  those  of  from  thirty  to  forty  years  ago,  in  view 
of  all  the  humanitarian,  hygienic,  and  medical  developments 
of  this  latter  period  ?  In  the  main,  the  conditions  favorable  to 


10 

better  health,  and  a  reduced  death-rate,  have  materially  im- 
prtived.  Has  there  been  a  corresponding  improvement  in  the 
general  health  of  infants,  and  a  corresponding  decrease  in 
the  death-rate  of  the  little  ones?  Only  the  official  vital  sta- 
tistics of  the  various  countries  can  answer  those  questions, 
and,  as  the  following  tables  will  demonstrate,  the  answer  is  a 
sadly  disappointing  one. 

The  first  attempt  of  any  importance  to  assemble  information 
on  these  lines,  subsequent  to  the  preparation  in  1890  of  the 
Bertillon  table  above  reproduced,  was  made  by  Dr.  Julius 
Eross,  and  its  results  embodied  in  a  paper  presented  before 
the  Section  for  Children-Hygiene  of  the  International  Congresses 
for  Hygiene  and  Demography  at  Budapest  in  1894,  under  the 
title  of  "Ueber  die  Sterblichkeitsverhaltnisse  der  Neugeborenen 
und  Sauglinge."  The  text  and  tables  of  Dr.  Eross's  paper  were 
subsequently  published  in  the  Zeitschrift  fur  Hygiene  und  Infec- 
tionskrankheiten,  the  important  work  periodically  published  at 
Leipzig  under  the  editorial  direction  of  Dr.  Robert  Koch  and 
Dr.  C.  Flligge,  and  the  statistics  therein  presented  form  a  con- 
necting link,  as  it  were,  between  those  of  the  Bertillon  table 
and  the  infant  mortality  figures  up  to  1905  especially  compiled 
by  the  writer  for  this  paper,  and  presented  in  subsequent  tables. 
The  statistical  data  of  Dr.  Eross's  paper  as  published  in  the 
Zeitschrift  (vol.  xix,  pp.  371-392)  begin  with  Table  I  (p.  372), 
showing  the 1 1  Infant  Mortality  of  0-1  Year  at  Rate  of  the  Living 
Born  and  the  Total  Mortality  in  Thirteen  European  States," 
which,  we  are  informed,  was  compiled  from  the  various  statis- 
tical year  books.  Translating  its  percentage  ratios  into  rates 
per  1,000,  for  the  sake  of  conformity  with  all  the  other  tabula- 
tions of  this  paper,  and  taking  the  liberty  of  substituting  in 
the  list  of  countries  for  the  name  of  Sweden  that  of  Norway, 
which  investigation  of  the  official  figures  for  both  countries 
proves  to  have  been  the  country  with  which  the  figures  given 
for  Sweden  were  identified,  the  table  is  as  follows: — 


TABLE   II. 

BIRTHS,  DEATHS  UNDER  AGE  1,  TOTAL  DEATHS,  AND  INFANT  MORTALITY  RATES  PER  1,000 
BIRTHS  AND  PER  1,000  TOTAL  DEATHS,  STILL-BIRTHS  EXCLUDED,  IN  THIRTEEN  OF 
THE  PRINCIPAL  EUROPEAN  COUNTRIES,  ACCORDING  TO  DR.  EROSS'S  TABLE. 


Rate  of 

Countries  and  Periods. 

Number  of 
Living 
Births. 

Died 
under 
1  Year. 

Rate 
per 
1,000 
Births. 

Total 
Mortality. 

Deaths 
under  1 
per  1,000 
Total 

Deaths. 

Ireland                 .    .    .      1884-88 

570,710 

54,049 

94 

439,635 

123 

Norway           ....     1881-90 

600,489 

58,471 

97 

331,209 

176 

Scotland      1885-90 

745,986 

89,858 

120 

446,179 

213 

England  (and  Wales)     1885-91 

6,234,373 

900,310 

144 

3,770,281 

238 

Belgium  1881-91 

1,940,197 

309,766 

159 

1,325,696 

233 

France     1885-90 

5,337,880 

882,909 

165 

5,049,223 

174 

(  1880-82  ) 
Holland  <  .,,-,«  r  /%/->  « 

1,332,266 

239,466 

179 

817,216 

293 

(  1885-90  ) 

Italy                                  1884-91 

8,980,579 

1,727,067 

192 

6,420,910 

268 

Prussia    1886-92 

7,681,839 

.1,594,039 

207 

4,622,216 

344 

Hungary     1884-87 

2,641,797 

560,220 

212 

1,912,419 

292 

Austria            ....      1886-87 

1,765,541 

435,763 

246 

1,350,760 

322 

Saxony        1886-92 

987,248 

277,857 

281 

639,208 

434 

Bavaria  1879-88 

2,014,195 

579,203 

287 

1,535,781 

376 

Totals      

40,833,100 

7,708,978 

183 

28,660,733 

269 

The  periods  of  observation  whose  returns  are  presented  in 
the  above  table  in  all  cases  overlap  on  the  period  with  which 
the  subsequent  table  for  the  last  twenty-five  years  deals,  and 
no  detailed  analysis  of  the  tabulation  of  Dr.  Eross  is  necessary 
at  this  point,  as  its  lessons  are  brought  out  with  intensified 
force  in  the  later  table.  That  is  to  say,  in  this  case,  as  in  all 
cases,  the  greater  includes  the  less.  It  may,  however,  be 
remarked,  en  passant,  that  all  the  countries  included  in  the 
above  table  were  also  named  in  the  Bertillon  table,  with  the 
single  exception  of  Hungary,  and  that  the  average  infant  mor- 
tality rate  per  1,000  living  births  in  those  twelve  countries  in 
the  period  covered  by  Bertillon's  table  was  186,  as  compared 
with  187  in  the  period  with  which  Dr.  Eross  dealt.  This 
startling  inflexibility  of  infant  mortality  rates,  when  measured 
by  broad  averages  of  either  countries  or  periods,  is  discussed 
at  some  length  on  subsequent  pages  of  this  paper. 


12 


VOF  THE 
N!  VERS (T Y 


13 


For  many  years  the  annual  reports  of  the  Registrar-General 
have  presented  the  most  compact  abstracts  anywhere  obtain- 
able of  the  birth-rates,  marriage-rates,  death-rates,  and  death- 
rates  under  1  year  to  each  1,000  children  born,  in  practically  all 
the  European  countries — and  certain  countries  in  other  sec- 
tions of  the  world.  Taking  those  tables  in  the  current  (sixty- 
ninth)  annual  report  as  a  basis,  the  writer  has  prepared  the 
following  tabulation,  which  affords  a  comprehensive  picture  of 
the  infant  mortality  experience  of  the  principal  countries  of 
Europe  and  Australasia  for  the  last  quarter  of  a  century.  The 
Registrar-General's  report  announces  that  in  each  case  the 
figures  were  obtained  from  the  statistical  department  of  the 
country  named,  and  that  still-births  have  been  eliminated 
in  the  case  of  both  births  and  deaths,  and  in  the  preparation 
of  the  following  tabulation  the  birth-rates  and  infantile  death- 
rates  for  each  five-year  period  named  have  been  obtained  by 
adding  the  rates  for  the  5  years  and  dividing  the  totals  by  5. 
The  general  averages  for  the  entire  period  under  observation 
have  been  deduced  by  adding  all  the  annual  rates  given  in  each 
case,  and  dividing  the  total  by  the  number  of  years  which  each 
total  represents.  Had  the  actual  numbers  of  births  and  deaths 
for  each  year  for  each  country  been  available — as  was  the  case 
with  the  restricted  table  of  Dr.  Eross — instead  of  the  birth- 
rates and  death-rates,  the  five-year  and  total  averages  of  course 
would  have  been  slightly  more  exact,  but  the  death  figures  are 
not  given  in  the  Registrar-General's  returns  from  other  coun- 
tries, and,  doubtless,  the  margin  of  error  is  so  narrow  as  to 
be  practically  inappreciable.  So  explained,  the  tabulation  in 
question  speaks  for  itself,  and  is  as  follows:— 


TABLE  III. 

BIRTH-RATES,  AND  DEATH-RATES  UNDER  AGE  1  PBR  1,000  BIRTHS,  OF  THE  PRINCIPAL,  FOREIGN 
COUNTRIES  FOR  THE  LAST  TWENTY-FIVE  TEARS,  BY  FIVE-YEAR  PERIODS  AND  FOR  THE  ENTIRE 
TWENTY-FIVE  YEAR  PERIOD — STILL-BIRTHS  EXCLUDED  IN  BOTH  CASES. 


v\ 

Countries. 

1881-85. 

1886-90. 

1891-95. 

1896-1900. 

1901-05. 

Averages. 
1881-1905. 

Births  per  1,000 
of  Population. 

Deaths  under  1 
per  1,000  Births. 

Births  per  1,000 
of  Population. 

Deaths  under  1 
per  1,000  Births. 

O  c 

rH*0 

fej 

&3 

»   ft 

A  O 

!* 

So 

30.2 
23.0 
27.5 
37.7 
30.5 
30.4 
31.8 
30.5 
27.7 
29.2 
43.3 
22.3 
32.8 
36.1 
35.3 
37.0 
41.0 
37.5 
41.7 
48.2 

Deaths  under  1 
per  1,000  Births. 

Births  per  1,000 
of  Population. 

Deaths  under  1 
per  1,000  Births. 

Births  per  1,000 
of  Population. 

Deaths  under  1 
per  1,000  Births. 

Births  per  1,000 
of  Population. 

Deaths  under  1 
per  1,000  Births. 

Norway     

31.2 
23.9 
29.4 
37.0 
33.3 
32.4 
35.5 
33.5 
28.6 
31.1 
46.3 
24.7 
34.8 
38.0 
36.4 
37.4 
41.8 
38.2 
44.4 
49.1 

99 
94 
116 
81 
117 
134 
162 
139 
171 
156 
157 
167 
181 
175 
193 
207 
182 
223 
226 
271 

30.8 
22.8 
28.8 
36.1 
31.4 
31.5 
34.5 
31.4 
27.5 
29.5 
43.7 
23.1 
33.6 
37.5 
36.0 
37.3 
40.9 
37.8 
43.5 
48.2 

96 
95 
105 
95 
121 
137 
144 
145 
159 
163 
158 
166 
175 
175 
186* 
208 
195 
883 
226 
264 

98 
102 
103 
140 
126 
139 
145 
151 
155 
164 
172 
171 
165 
185 
185 
205 
220 
223 
250 
276 

30.2 
23.3 
26.9 
41.3 
30.0 
30.0 
32.6 
29.3 
28.5 
28.9 
40.0 
22.0 
32.1 
34.0 
34.3 
36.5 
40.2 
37.3 
39.4 
49.3 

96 
106 
101 
143 
129 
132 
139 
156 
143 
158 
159 
159 
151 
168 
185 
201 
216* 
226 
219 
261 

28.6 
23.2 
26.1 
40.9 
2S.9 
29.0 
31.4 
28.1 
28.1 
27.7 
38.8 
21.3 
31.6 
32.6 
35.3 
34.9 
39.4 
35.6 
37.2 
48.6 

81 
98 
92* 
145* 
120 
119 
131 
138 
134 
148 
149 
139 
136 
168 
173 
190 
203 
213* 
212 
268 

30.2 
23.2 
27.7 
38.6 
30.8 
30.7 
33.2 
30.6 
28.1 
29.3 
42.4 
22.7 
33.0 
35.6 
35.5 
36.6 
40.7 
37.3 
41.2 
48.6* 

94 
99 
104* 
120* 
123 
132 
144 
146 
153 
158 
159 
160 
162 
175* 
185* 
202 
203* 
223* 
226* 
268* 

Ireland       

Sweden      

Bulgaria    

Scotland    

Finland 

England  and  Wales, 
Switzerland  .... 

Servia                     .    . 

France                   .    . 

The  Netherlands  .    . 
Italy                       .    . 

Spain                      .    . 

Prussia               .    .    . 

Roumania     .... 
Austria  
Hungary    
Russia  in  Europe 

Averages  for  Europe, 

35.3 

163 

34.3 

162 

33.7 

169 

33.3 

162 

32.4 

153 

33.8 

162 

New  Zealand    .    .    . 
Tasmania  

36.3 
34.5 
38.5 
36.5 
37.7 
30.8 
34.5 

90 
109 
101 
136 
124 
122 
1S5 

31.2 
34.6 
34.7 
37.4 
36.4 
32.7 
37.0 

84 
103 
105 
119 
115 
131 
123 

27.7 
32.7 
32.0 
34.1 
32.9 
31.0 
31.4 

87 
94 
99 
103 
111 
111 
130 

25.7 
28.2 
27.0 
29.2 
28.0 
26.2 
27.9 

80 
98 
112 
104 
113 
111 
160 

26.6 
29.0 
24.5 
26.7 
26.7 
24.9 
30.3 

75 
90 
87 
95 
97 
96 
126 

29.5 
31.9 
31.3 
32.8 
32.3 
29.1 
32.2 

83 
99 
101* 
111 
112 
114 
135* 

South  Australia    .    . 
Queensland   .... 
New  South  Wales    . 
Victoria     
Western  Australia    . 

Averages  for  Austral- 
asia           .    . 

35.5 

117 

34.9 

111 

31.7 

105 

27.5 

m 

27.0 

31.8 
38.6 
39.0 
35.2 

95 

31.3 

29.2 
33.2 
38.1 
36.2 

108 

Japan 

26.0 
28.6 
37.6 
39.4 

104 
158 
158 

314 

28.5 
30.2 
36.7 
35.2 

116 
158 
170 
264 

28.6 
31.7 
38.4 
37.2 

147 
169 
171 
336 

31.1 
37.1 
38.9 
34.1 

153 
168 
175 
333 

154 
171 
174 
332* 

135 
165 
169 
314* 

196 

Ceylon    
Jamaica     

Chili 

Averages   for    Coun- 
tries Named  .    .    . 

32.9 

184 

32.7 

177 

34.0 

206 

35.3 

207 

36.2 

208 

34.2 

RECAPITULATION. 


Europe  

35.3 

163 

34.3 

162 

33.7 

169 

33.3 

162 

32.4 

153 

33.8 

162 

Australasia  .... 
Other  Lands  .  .  . 

35.5 
32.9 

117 
184 

34.9 
32.7 

111 

177 

31.7 
34.0 

105 
206 

27.5 
35.3 

111 
207 

27.0 
36.2 

95 

208 

31.3 
34.2 

108 
196 

fGrand  Averages  . 

35.1 

155 

34.2 

152 

33.3 

159 

32.2 

157 

31.6 

147 

33.3 

154 

*  Returns  for  one  or  more  years  wanting,  and  averages  have  been  calculated  on  basis  of 
returns  for  other  years  of  period  in  question. 

t  Computed  by  division  of  totals  for  all  countries  represented  in  table  by  number  of 
countries  in  question. 

Italicized  figures  represent  estimates  for  periods  for  which  no  returns  were  available,  estimate 
in  each  case  being  average  of  actual  returns  for  balance  of  entire  twenty-five  year  period. 


15 


So  far  as  the  writer  is  aware,  the  preceding  table  is  the  first 
detailed  comparison  ever  compiled  of  the  birth-rates  and  infan- 
tile death-rates  of  the  leading  countries  of  the  world  by  five- 
year  periods  for  an  entire  quarter  of  a  century,  and  the  con- 
tinuity of  comparisons  sheds  considerable  light  on  many 
mooted  questions  which  have  been  raised  in  the  protracted 
discussion  of  infant  mortality.  Unfortunately,  in  a  few  cases 
returns  were  wanting,  and  in  order  to  round  out  the  averages 
for  the  periods  and  countries  in  question  it  was  necessary  to 
substitute  estimates  for  actual  returns.  As  stated  in  the  ap- 
pended foot-note,  however,  all  estimates  for  five-year  periods 
were  based  on  the  averages  of  returns  for  the  balance  of  the 
twenty-five  year  period,  and  the  margin  of  error,  therefore, 
is  probably  so  slight  as  to  make  no  material  difference  in  the 
general  showing. 

The  first  and  all-important  point  to  be  noted  in  the  tabula- 
tion is  the  uniformity  of  the  infantile  death-rate  for  the  world 
at  large  for  the  last  quarter  of  a  century,  and  its  comparatively 
slight  fluctuations  by  five-year  periods  in  particular  countries 
or  sections  of  the  world.  Thus  it  will  be  noted,  in  the  thirty- 
one  widely  remote  countries  for  which  returns  are  presented, 
in  1881-85  the  rate  of  infant  deaths  per  1,000  births  was  155,  and 
in  the  period  terminating  twenty  years  later  was  practically 
identical,  then  standing  at  154.  As  is  shown  by  a  subsequent 
table  herein  presented,  the  apparent  infantile  death-rate  in 
this  country  in  the  States  recognized  as  registration  States 
at  the  time  of  the  Twelfth  Census  was  144.7  in  1900  and  162.6 
in  1890,  thus  averaging  153.7;  and,  as  is  demonstrated  by 
another  table  showing  the  annual  infant  mortality  rates  in 
Massachusetts  from  1856  to  1905,  the  average  infant  death- 
rate  under  age  1  per  1,000  living  births  in  that  Commonwealth 
for  the  last  fifty  years  has  been  152.4.  Succinctly  stated,  the 
infantile  death-rates  for  these  various  sections  and  periods  were 
as  follows: — 


16 


TABLE   IV. 

THE  UNIFORMITY  OF  THE  INFANTILE  DEATH-RATE  IN  ALL  SECTIONS  OF  THE  WORLD  IN 

RECENT  YEARS. 


Sections. 

Periods  of 
Observation. 

Deaths  under 
Age  1  per 
1,000  Births. 

31  Countries  of  Europe,  Australasia,  and  other  lands 
Registration  States  of  the  United  States  in  1900  . 
State  of  Massachusetts 

1881-1905 
*  1890  and  1900 
1856-1905 

154 
153.7 
152  4 

*  Census  years  ending  May  31. 

In  view  of  the  many  material  changes  in  the  living  habits 
and  industrial  conditions  of  the  world's  population  in  the  last 
generation,  the  great  advance  in  medical  knowledge,  and  the 
marked  decrease  in  the  general  death-rate,  the  practical  uni- 
formity of  the  infantile  death-rate  the  world  around  is  simply 
astounding.  On  the  face  of  the  above  showing  it  apparently 
has  a  regularity  in  keeping  with  that  of  the  American  Experi- 
ence Table  of  mortality;  and,  bearing  in  mind  the  point  noted 
in  H.  Llewellyn  Heath's  book, — namely,  that  in  the  sixteenth 
century  the  infant  deaths  constituted  25.9  per  cent,  of  all  the 
deaths  at  Geneva  and  in  1904  were  25  per  cent,  of  all  the  deaths 
in  England  and  Wales, — there  is  an  almost  weird  suggestion  of 
the  pitiless  inflexibility  of  Fate  in  the  death-rate  of  infants. 
Of  course  there  are  wide  variations  in  the  infant  death-rates 
of  individual  communities,  but,  as  the  tables  herewith  presented 
will  show,  the  fluctuations  in  long-established  and  stable  com- 
munities would  seem  to  be  comparatively  slight,  and,  as  has 
apparently  been  demonstrated  by  the  preceding  tables,  when 
a  really  broad  average  has  been  attained  the  change  in  the 
infantile  death-rate  of  the  world  at  large  in  a  long  stretch  of 
years  apparently  is  almost  infinitesimal. 

In  most,  if  not  all,  countries — and  certainly  in  nearly  all 
the  States  of  the  United  States — there  are  more  or  less  serious 
defects  in  the  registration  of  vital  statistics,  especially  in  the 
recording  of  births.  That  subject  has  been  so  thoroughly 


17 

threshed  out  as  to  call  for  no  comment  here.  But,  to  a  certain 
extent,  the  defects  of  one  country's  registration  system  would 
be  offset  by  the  comparative  perfection  of  that  in  force  in  some 
other  country,  in  a  tabulation  of  world-wide  scope,  and  in  the 
case  of  the  twoscore  countries  and  States  dealt  with  in  the  last 
table  it  is  not  improbable  that  the  percentage  of  error  is  sub- 
stantially uniform.  Even  were  the  inquiry  restricted  to  the 
two  English-speaking  sections  whose  registration  systems  are 
generally  regarded  as  freest  from  defects — to  wit,  England 
and  Wales  on  one  side  of  the'  Atlantic  and  the  State  of  Massa- 
chusetts on  this  side  of  the  water— the  variations  in  their  infant 
mortality  rates  in  the  last  twenty-five  years  and  the  averages 
for  the  entire  period  differ  but  slightly,  the  infant  death-rates 
in  England  and  Wales  for  the  five  latest  five-year  periods  hav- 
ing been  in  the  order  of  139, 145,  151,  156,  and  138,  and  those  of 
Massachusetts  for  the  same  periods  having  been  160,  161,  161, 
153,  and  138.  The  widest  range  of  five-year  variation  in  the 
case  of  England  and  Wales  was  18  per  1,000  births,  and  that 
in  the  case  of  Massachusetts  23  per  1,000  births.  Their 
respective  averages  for  the  twenty-five  year  period  were  146 
and  154. 

In  the  tabulation  of  infant  mortality  in  the  principal 
countries  of  Europe  compiled  and  published  in  1890  by  Dr. 
Bertillon  and  reproduced  in  transposed  form  on  a  previous 
page  of  this  paper,  the  latest  date  of  observation  was  the  year 
1883, — that  is  to  say,  twenty-five  years  ago, — and  some  of  the 
figures  dated  back  to  1862.  In  those  days  the  registration  of 
vital  statistics  in  many — if  not  most — of  the  countries  of 
Europe  was  far  less  advanced  than  it  has  become  of  late  years, 
and,  taking  into  account  the  well-known  fact  that  approximate 
completeness  in  the  registration  of  deaths  almost  inevitably 
precedes  that  of  registration  of  births,  it  might  naturally  be 
assumed  that  the  apparent  rates  of  infant  deaths  to  births 
would  have  been  much  larger  in  the  case  of  the  records  of 
1862-1883  than  in  those  of  1881-1905,  the  divisor  in  the  pre- 
vious calculation  presumably  having  been  much  farther  re- 
moved from  the  correct  figure.  As  to  how  well  founded  that 


18 


assumption  proves,  the  following  comparison  of  the  death- 
r&tes  in  the  Bertillon  table  and  that  compiled  by  the  writer  of 
this  paper  will  indicate. 

Some  considerable  apparent  decreases  in  the  infant  mortality 
rates  of  certain  countries  are  to  be  noted  in  the  following  table, 


TABLE  v. 

A  COMPARISON  OF  THE  INFANT  MORTALITY  IN  THE  PRINCIPAL  COUNTRIES  OP  EUROPE  IN 
THE  LAST  TWENTY-FIVE  YEARS  WITH  THE  EARLIER  PERIODS  NAMED  IN  BERTILLON'S 
TABLE  AND  THE  DECREASE  OR  INCREASE  AND  RELATIVE  RANK  IN  THE  CASE  OF  EACH 
OF  THE  COUNTRIES. 


Infant  Mortality 
in  Periods  Named. 

Deaths 
per  1,000 
Births, 
1881- 
1905. 

Decrease 
or 
Increase. 

Rank  in  Order  of 
Lowest  Infant 
Mortality. 

Period  of 
Observa- 
tion. 

Deaths 
per  1,000 
Births. 

Early 
Period. 

Later 
Period. 

Ireland  .... 

1865-83 
1866-82 
1865-81 
1866-82 
1870-82 
1867-83 
1866-82 
1878-80 
1875-82 
1878-81 
1869-80 
1874-82 
1872-83 
1875-82 
1866-83 
1867-78 

95.9 
104.9 
122.0 
131.9 
137.5 
148.2 
149.2 
164.9 
166.2 
193.2 
195.2 
207.8 
209.7 
250.0 
255.3 
266.8 

99 
94 
123 
104 
132 
158 
146 
144 
160 
162 
153 
202 
175 
203 
223 
268 

3.1* 
10.9 
1.0* 
27.9 
5.5 
9.8* 
3.2 
20.9 
6.2 
31.2 
42.2 
5.8 
34.7 
47.0 
32.3 
1.2* 

1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 

2 
1 
4 
3 
5 
9 
7 
6 
10 
11 
8 
13 
12 
14 
15 
16 

Norway     

Scotland    

Sweden      

Denmark 

Belgium    
England  and  Wales     . 
Finland     

France    

The  Netherlands      .    . 
Switzerland 

Prussia 

Italy 

Roumania     .... 

Austria      

Russia  in  Europe     .    . 

Averages              .    . 

174.9 

159.1 

15.8 

*  Increase. 

and  on  the  face  of  the  returns  it  would  seem  that  those  coun- 
tries were  to  be  congratulated  on  having  somehow  succeeded 
in  devising  ways  and  means  of  reducing  this  phase  of  the 
mortality  problem  in  which  the  vast  majority  of  countries  have 
notably  failed,  whether  through  lack  of  serious  attention  to 
the  subject  or  for  other  reasons.  But  is  such  the  case?  Let 


19 

us  go  behind  the  returns,  locate  the  countries  which  have  scored 
the  largest  apparent  decreases,  and  consider  for  a  moment 
whether  those  countries  might  naturally  be  expected  to  be 
found  in  the  forefront  of  the  movement  for  the  reduction  of 
infant  mortality. 

Of  the  sixteen  countries  named  in  the  table,  eight  show  an 
apparent  annual  decrease  of  more  than  10  deaths  per  1,000 
births  since  the  early  80's,  the  decrease  ranging  from  10.9  in 
the  case  of  Norway  up  to  the  remarkable  figure  of  47  in  the 
case  of  Roumania,  and  the  other  countries  in  the  order  of  the 
largest  seeming  decrease  being  Switzerland,  Italy,  Austria,  the 
Netherlands,  Sweden,  and  Finland.  And  yet  none  of  these 
countries  has  ever  attained  any  particular  prominence  in  the  cru- 
sade for  the  protection  of  children's  lives.  Austria  is  the  only 
one  of  the  eight  which  could  be  even  seriously  considered  as 
among  the  great  European  powers,  and,  as  will  be  noted,  none 
of  the  indisputably  first-class  powers  appears  in  the  list.  In 
England,  France,  and  Prussia  the  decrease  in  the  death-rate 
was  merely  nominal,  and,  as  the  registration  systems  of  those 
countries  would  probably  be  regarded  as  superior  to  that  in 
any  of  the  eight  countries  which  have  scored  the  apparent  large 
decreases  in  the  infant  death-rate,  it  would  seem  not  only  pos- 
sible, but  extremely  probable,  that  the  decrease  in  the  last-named 
countries  was  more  apparent  than  real — in  other  words,  was  a 
decrease  in  figures  only,  very  likely  due  to  the  material  increase 
in  the  registration  of  births  and  the  consequent  decrease  in  the 
ratio  of  deaths  under  age  1  to  births.  In  England,  France,  and 
Prussia  the  registration  of  births  was  probably  much  more 
complete  thirty  or  forty  years  ago  than  in  most  of  the  smaller 
countries  of  Europe,  and,  if  such  was  the  case,  there  naturally 
would  be  much  less  fluctuation  in  the  mortality  rates  in  the 
case  of  those  leading  countries.  Therein  probably  lies  the  ex- 
planation of  most  of  the  apparent  large  decreases  in  the  last 
twenty-five  years. 

In  default  of  positive  evidence  it  would  be  absurd  to  believe 
that  the  little  country  of  Roumania,  with  its  limited  resources, 
had  succeeded  in  effecting  a  reduction  of  its  infant  death-rate 


20 

by^  nearly  20  per  cent,  in  the  last  twenty-five  years,  and  thereby 
materially  distanced  every  other  country  in  the  world.  Further- 
more, as  shown  in  Table  III,  the  record  of  its  infant  death- 
rates  by  five-year  periods  proves  that  the  rate  has  been  almost 
continuously  in  the  ascendant  for  that  same  period.  The  British 
Registrar-General's  office  was  unable  to  obtain  any  infantile 
death-rates  from  Austria  up  to  1896,  or  from  Italy  up  to  1891, 
and  in  those  obtained  since  those  dates  there  is  no  sign  of  any 
sharp  decline.  Norway,  Sweden,  Finland,  the  Netherlands,  and 
Switzerland  have  apparently  shown  material  decreases  in  the 
infant  death-rate  in  most  of  the  five-year  periods  of  the  last 
quarter  of  a  century,  but  improved  registration  of  births  prob- 
ably accounts  for  that  fact  in  most,  if  not  all,  of  those  cases, 
and  it  would  therefore  seem  that  the  pronounced  differences 
in  some  cases  between  the  death-rates  of  the  old-time  Bertillon 
table  and  the  up-to-date  table  presented  in  connection  with 
this  study  are  unworthy  of  any  serious  attention.  In  the  face 
of  the  surprising  uniformity  of  the  mortality  rate  in  question 
in  the  world  at  large,  and  especially  in  countries  having 
thoroughly  established  registration  systems,  only  the  most  ir- 
refutable evidence  will  convince  any  student  of  infant  mor- 
tality of  a  permanent  reduction  in  the  infant  death-rate  in 
any  country  up  to  this  time. 

In  so  far  as  the  infantile  death-rate  in  the  United  States  as 
a  whole — either  now  or  at  any  previous  time — is  concerned, 
there  are  absolutely  no  authentic  data.  In  his  contribution  to 
the  Eleventh  Census  Report  on  Vital  and  Social  Statistics, 
published  in  1896,  Dr.  Billings  accounted  for  that  fact  by  au- 
thoritatively stating  (Part  I,  p.  21)  that  "we  have  no  fully  com- 
plete and  accurate  registration  of  births  in  any  part  of  the 
United  States.  The  most  accurate  registration  is  probably  in 
Massachusetts,  in  which  it  is  estimated  that  the  deficiency  is 
not  greater  than  2  per  cent."  Again,  in  Volume  III  of  the 
Twelfth  Census  Reports  (Vital  Statistics,  Part  I,  p.  xlix)  the 
late  William  A.  King,  Chief  Statistician  for  Vital  Statistics, 
commenced  his  discussion  of  births  with  the  admission  that 
"the  data  relating  to  births  are  the  most  incomplete  and  unsatis- 


21 


factory  of  any  treated  in  this  report.  Were  it  not  considered 
desirable  to  give  such  results  as  bear  upon  the  question  for  the 
information  of  students  of  the  statistics,  the  subject  might  be 
dismissed  with  the  statement  that  they  are  entirely  inadequate 
to  determine,  directly,  the  general  birth-rate  of  the  country,  or, 
what  is  of  equal  practical  importance,  the  relative  birth-rate 
of  different  classes  of  population.  A  number  of  the  States  and 
cities  have  laws  requiring  the  registration  of  births,  but  it  is 
doubtful  if  there  is  a  single  place  in  which  births  are  registered 
as  fully  as  deaths." 


DIAGRAM  II.— THE  INFANT  MORTALITY  RATES  OF  ENGLAND  AND  WALES, 
PRUSSIA,  FRANCE,  AND  THE  STATE  OF  MASSACHUSETTS  BY  FIVE-YEAR 
PERIODS  FROM  1881  TO  1905,  ON  THE  BASIS  OF  DEATHS  UNDER  1  YEAR 
PER  1,000  BIRTHS,  STILL-BIRTHS  EXCLUDED. 


210 

Deaths  per  1 ,000  Birth? 
PRUSSIA 

200 


190 
180 

170 
FRANCE    

MASSACHUSETTS  .    160 
150 


140 
ENGLAND  AND  WALES 


130 
Prussia; 


France; 


Massachusetts ; England  and  Wales. 


22 

£s  the  census  authorities  have  repeatedly  stated,  the  data 
regarding  the  number  of  living  children  under  1  year  of  age  are 
also  utterly  incomplete  and  inaccurate,  owing  to  the  fact  that 
the  number  so  returned  is  too  small  in  practically  all  localities, 
partly  owing  to  the  practically  universal  tendency  to  report 
children  in  the  later  months  of  the  first  year  as  1  year  old.  For 
these  reasons  it  would  be  utterly  futile  to  attempt  the  com- 
pilation of  any  figures  of  the  infant  mortality  rate  in  the  United 
States  at  large  for  purposes  of  comparison  with  the  returns  for 
other  countries  presented  in  the  preceding  tables.  In  the  Regis- 
trar-General's annual  reports  for  some  years  past,  returns  of 
this  character  from  thirty-two  countries  have  been  presented, 
but  the  United  States  has  been  the  one  great  country  in  the 
world  for  which  no  figures  were  given. 

In  the  light  of  these  conditions  it  might  at  first  seem  practi- 
cally impossible  to  obtain  even  an  approximate  idea  of  the  status 
of  infant  mortality  in  this  country,  but  such  is  not  the  case,  the 
number  of  registration  States  and  the  magnitude  of  their  com- 
bined population  being  sufficient  to  afford  a  fairly  accurate  index 
of  the  conditions  in  Continental  United  States  as  a  whole.  The 
registration  systems  of  these  States  greatly  differ  in  point  of 
comprehensiveness  and  reliability,  but  by  common  consent 
that  of  Massachusetts  is  regarded  as  of  foremost  importance, 
and  the  complete  record  of  infant  deaths  in  that  State  for  the 
last  half-century  undoubtedly  affords  by  far  the  best  available 
standard  of  measurement  and  comparison  in  a  study  of  infant 
mortality  in  this  country.  In  the  Twenty-eighth  Annual  Re- 
port of  the  State  Board  of  Health  of  Massachusetts,  published 
in  1897,  there  appeared  a  comprehensive  study  of  "The  Vital 
Statistics  of  Massachusetts — A  Forty  Years'  Summary/7  which 
was  prepared  by  Dr.  Samuel  W.  Abbott,  secretary  of  the 
Board  of  Health.  This  chapter  of  more  than  100  pages  (pp. 
711-829)  begins  with  a  graphic  tracing  of  the  "Marriage,  Birth, 
and  Death  Rates  and  Infantile  Death-rate,  Massachusetts,  40 
Years,  1856-95,"  and  contains  a  complete  tabulation  of  "Infant 
Mortality,  Massachusetts,  1856-95,  Forty  Years,"  presenting 
the  annual  figures  for  each  of  those  years. 


23 

For  some  reason  not  explained  in  the  text,  the  birth  statis- 
tics in  that  tabulation  begin  with  July  1,  1856,  and  end  with 
June  30,  1895,  whereas  the  deaths  under  1  year  in  the  same 
table  are  taken  from  the  calendar-year  records,  thus  making 
the  birth  and  death  rate  figures  materially  differ  from  those  in 
the  twenty-year  infant  mortality  record  presented  in  recent 
Massachusetts  registration  reports  of  births,  marriages,  and 
deaths.  It  has  seemed  desirable  to  eliminate  this  discrepancy, 
and  the  following  tabulation  of  infant  mortality  in  Massachusetts 
for  the  fifty  years  ending  Dec.  31,  1905,  has  therefore  been 
compiled  in  part  from  Dr.  Abbott's  table  of  infant  mortality 
(p.  750),  in  so  far  as  deaths  under  1  from  1856  to  1895,  inclusive, 
are  concerned,  and  partly  from  his  tabulation  of  marriages, 
births,  and  deaths  from  1842  to  1895  (pp.  721-722),  the  supple- 
mental figures  for  births  and  infant  deaths  in  the  calendar  years 
1896  to  1905,  inclusive,  being  taken  from  the  twenty-year  table 
of  infant  mortality  in  the  current  (sixty-fifth)  Massachusetts 
Report  of  Births,  Marriages,  and  Deaths  (p.  205).  The  com- 
posite tabulation  of  infant  mortality  herewith  presented  is  thus 
made  complete  for  the  fifty  calendar  years  ending  with  1905, 
and,  in  order  to  permit  of  comparison  with  the  statistics  of 
foreign  countries  presented  in  the  previous  tables  accompanying 
this  article,  is  supplemented  with  a  column  containing  the  annual 
birth-rates  in  Massachusetts  for  the  last  fifty  calendar  years,  as 
presented  in  the  Sixty-fifth  Massachusetts  Report  of  Births,  Mar- 
riages, and  Deaths  (pp.  141-142).  Still-births  have  been  ex- 
cluded in  all  cases. 


TABLE  VI. 

A  COMPLETE  RECORD  OF  BIRTHS,  DEATHS  UNDER  AGE  1,  THE  INFANTILE  DEATH-RATE 
PER  1,000  BIRTHS,  AND  THE  BIRTH-RATE  IN  MASSACHUSETTS  FOR  EACH  OF  THE  FIFTY 
YEARS  1856-1905,  INCLUSIVE,  EXCLUDING  STILL-BIRTHS. 


Calendar  Year. 

Births. 

Deaths  under  1  Year. 

Birth-rate 
per  1,000 
Population. 

Number. 

Rate  per 
1,000  Births. 

1856   

34,445 
35,320 
34,491 
35,422 
36,051 
35.445 
32,275 
30,314 
30,449 
30,249 
34,085 
35,062 
36,193 
36,141 
38,259 
39,791 
43,235 
44,481 
45,631 
43,996 
42,149 
41,850 
41,238 
40,295 
44,217 
45,220 
45,670 
47,285 
48,615 
48,790 
50,788 
53,174 
54,893 
57,075 
57,777 
63,004 
65,824 
67,192 
66,936 
67,545 
72,343 
73,205 
73,110 
70,457 
73,386 
71  ,976 
72,219 
73,584 
75,014 
75,022 

4,226 
4,160 
4,197 
4,175 
4,821 
5,167 
4,216 
4,545 
4,693 
4,869 
4,699 
4,763 
5,421 
5,368 
6.206 
5,996 
8,390 
7,911 
7,489 
7,712 
6,700 
6,343 
6,189 
5,855 
7,190 
7,389 
7,445 
7,515 
7,735 
7,625 
7,848 
8,514 
8,870 
9,105 
9,625 
10,186 
10,649 
10,990 
10,899 
10,564 
11,765 
10,751 
11,012 
10,532 
11,500 
9,952 
10,075 
10,269 
9,992 
10,519 

122.7 
117.8 
121.7 
117.9 
133.7 
145.8 
130.6 
149.9 
154.1 
161.0 
137.9 
135.8 
149.8 
148.5 
162.2 
150.7 
194.1 
177.8 
164.1 
175.3 
159.0 
151.5 
150.1 
145.3 
162.6 
163.4 
163.0 
158.9 
159.1 
156.3 
154.5 
160.1 
161.6 
159.5 
166.6 
161.7 
161.7 
163.6 
162.8 
156.4 
157.8 
146.9 
150.6 
149.5 
156.7 
138.3 
139.5 
138.3 
133.2 
140.2 

29.91 
30.17 
28.97 
29.28 
29.28 
28.63 
25.92 
24.20 
'  24.17 
23.87 
26.16 
26.17 
26.26 
25.50 
26.25 
26.63 
28.21 
28.31 
28.32 
26.63 
25.12 
24.57 
23.85 
22.95 
24.80 
24.93 
24.75 
25.14 
25.46 
25.12 
25.42 
25.86 
25.95 
26.23 
25.81 
27.53 
28.13 
28.09 
27.37 
27.02 
28.27 
27.96 
27.29 
25.70 
26.16 
25.07 
24.58 
24.48 
24.39 
24.98 

1857  

1858  

1859  

I860 

1861 

1862 

1863   

1864   

1865  

1866  

1867 

1868 

1869 

1870         .  . 

1871     .   ... 

1872  

1873 

1874 

1875 

1876 

1877      .... 

1878  

1879  

1880  

1881 

1882 

1883          .  . 

1884  

1885  

1886  

1887  

1888 

1889 

1890  . 

1891  

1892  

1893  

1894 

1895 

1896  .  . 

1897  

1898  

1899  

1900 

1901  . 

1902  

1903  

1904  

1905 

Totals  

2,511,188 

382,627 

152.4 

26.32 

Thanks  to  the  early  establishment  of  the  registration  system 
of  Massachusetts,  recognized  the  world  over  for  many  years  as 
the  most  reliable  index  of  American  vital  statistics,  the  preced- 
ing table  unquestionably  affords  by  far  the  most  comprehensive 
and  most  authoritative  tracing  of  infant  mortality  in  at  least 
one  section  of  this  country  which  is  now  obtainable  from  any 
or  all  sources.  The  pronounced  annual  fluctuations  in  both 
birth  and  death  rates  are  somewhat  misleading,  however,  and 
the  appended  tabulation  of  births  and  infant  deaths  by  five-year 
periods  not  only  puts  the  case  much  more  comprehensibly,  but 
also  reduces  the  Massachusetts  tabulation  to  the  basis  followed 
in  the  preceding  foreign  tabulations,  and  thus  makes  possible  a 
comparison  by  five-year  periods.  Thus  arranged,  the  state- 
ment of  births  and  infant  deaths  in  Massachusetts  for  the  last 
half-century  is  as  follows : — 

TABLE   VII. 

BIRTHS,  BIRTH-RATES  PER  1,000  POPULATION,  AND  DEATHS  UNDER  1  YEAR  AND  THEIR 
RATE  PER  1,000  BIRTHS  IN  MASSACHUSETTS  BY  FIVE-YEAR  PERIODS  FOR  THE  FIFTY 
YEARS  1856-1905,  INCLUSIVE — STILL-BIRTHS  EXCLUDED  IN  BOTH  CASES. 


Five-  Year  Periods. 

Living  Births. 

Deaths  under  1  Year. 

Number. 

Birth-rate 
per  1,000 
Population. 

Number. 

Rate  per 
1,000  Births. 

1856-60   

175,729 
158,732 
179,740 
217,134 
209,749 
235,580 
273,707 
330,501 
362.501 
367,815 

29.52 
25.36 
26.07 
27.62 
24.26 
25.09 
25.85 
27.63 
27.08 
24.70 

21,579 
23,490 
26,457 
37,498 
32,277 
37,709 
43,962 
53,288 
55,560 
50,807 

122.8 
148.0 
147.2 
172.7 
153.9 
160.1 
160.6 
161.2 
153.3 
138.1 

1861-65   

1866-70   

1871-75 

1876-80 

1881-85 

1886-90   

1891-95  

1896-1900   

1901-05   

Totals  

2,511,188 

26.32 

382,627 

152.4 

RECAPITULATION  BY  TWENTY-FIVE  YEAR  PERIODS. 


1856-1880 

941  084 

26  57 

141  301 

1*>0  1 

1881-1905 

1  570  104 

2607 

241  326 

ico  7 

26 


When  the  summary  for  the  last  twenty-five  years,  in  the  last 
line  of  this  table,  is  compared  with  the  corresponding  figures 
for  foreign  countries  presented  in  Table  III  of  this  paper,  one  is 
immediately  impressed  with  the  surprising  uniformity  of  the 
infant  mortality  rate  the  world  around,  which  has  already  been 
alluded  to.  In  the  thirty-one  foreign  countries,  in  widely  re- 
mote parts  of  the  world,  dealt  with  in  Table  III,  the  general 
average  of  deaths  under  1  year  to  each  1,000  births  in  the 
twenty-five  years  ending  with  1905  was  154:  in  the  same  period 
the  infant  death-rate  in  Massachusetts  was  153.7.  In  the 
twenty  European  countries  whose  returns  are  presented  in 
Table  III — Austria,  Hungary,  and  Russia,  with  their  abnormally 
high  death-rates,  included — the  average  infant  death-rate  for 
the  last  twenty-five  year  period  was  162  a^  compared  with  the 
Massachusetts  rate  of  153.7,  and  for  the  five  five-year  periods 
involved  the  European  infant  death-rates  were,  in  order,  163, 
162,  169,  162,  and  153,  as  compared  with  death-rates  of  160.1, 
160.6,  161.2,  153.3,  and  138.1  in  Massachusetts.  In  fact,  the 
correspondence  between  the  infant  death-rates  of  Europe  and 
its  leading  countries  and  those  of  Massachusetts  is  so  strik- 
ingly close  that  it  can  only  be  appreciated  by  means  of  a  tabu- 
lar statement,  such,  for  instance,  as  the  following: — 


TABLE  VIII. 

A  COMPARISON  OP  THE  INFANT  MORTALITY  RATES  PER  1,000  BIRTHS  OP  THE  WORLD  AT 
LARGE  AND  LEADING  EUROPEAN  COUNTRIES  WITH  THOSE  OP  MASSACHUSETTS  BY 
FIVE-YEAR  PERIODS,  1881-1905,  INCLUSIVE. 


1881 
to 
1885. 

1886 
to 
1890. 

1891 
to 
1895. 

1896 
to 
1900. 

1901 
to 
1905. 

1881 
to 
1905. 

31  foreign  countries  in  all  parts  of  the  world    .    .    . 

155 
163 

152 
162 

159 
169 

157 
162 

147 
153 

154 

162 

England  and  Wales,  France  and  Prussia  
England  and  Wales  and  France 

171 
153 

173 

156 

176 
161 

172 

158 

156 
139 

169 
153 

MASSACHUSETTS                                                       .    . 

160 

161 

161 

153 

138 

154 

27 

This  table  tells  its  own  story,  and  would  seem  to  prove  beyond 
all  peradventure  that  there  is  a  general  uniformity  in  the  un- 
dulations of  the  infant  mortality  wave  at  various  periods,  in 
the  world  at  large,  however  mysterious  and  inexplicable  may 
be  the  undiscovered  influences  which  regulate  it.  As  will  be 
observed,  in  all  the  different  groups  of  countries  above  presented, 
there  was  a  gradual  rise  in  the  death-rate  up  to  1891-95,  and  a 
gradual  falling  from  1895  to  1905,  in  each  case  the  top  notch 
being  arrived  at  in  1891-5,  and  in  every  case  except  that  of 
Massachusetts  the  death-rate  for  the  entire  twenty-five  year 
period  being  practically  identical  with  that  of  the  first  five-year 
period.  The  Massachusetts  rate  for  the  twenty-five  years  was 
lower  by  6  deaths  per  1,000  births  than  was  the  rate  for  the 
first  five  years,  wheims  in  the  case  of  all  the  other  sections  of 
the  world  named  the  largest  decrease  in  the  twenty-five  year 
average  as  compared  with  the  rate  for  the  first  five  years  was 
only  2  deaths  per  1,000  births;  and  the  comparison  of  the  Massa- 
chusetts figures  with  those  for  England  and  Wales,  France,  and 
Prussia,  is  a  particularly  reliable  one  for  the  reason  that  the 
registration  systems  of  those  sections  are  presumably  freer  from 
error  than  any  others  which  could  be  selected. 

In  short,  this  latest  tabulation  strongly  confirms  the  broad 
average  showings  of  Table  III,  and  again  suggests  the  question 
before  raised — namely,  why  this  surprising  uniformity  in  the 
infant  death-rate  the  world  around?  Furthermore,  why  the 
general  rise  in  the  death-rate  from  1881  to  1895,  and  why  the 
general  fall  in  the  death-rate  from  the  last-named  date  down  to 
1905?  No  living  man  can  rationally  answer  those  grave  ques- 
tions. It  would  be  pleasant  to  believe  that,  as  the  world  ad- 
vances in  knowledge,  in  hygiene  and  sanitation,  and  in  humani- 
tarianism,  infant  mortality  correspondingly  decreases;  but  only 
a  substantially  continuous  decline  in  the  infant  death-rate 
for  a  long  term  of  years,  in  countries  with  thoroughly  estab- 
lished registration  systems,  could  substantiate  any  such  opti- 
mistic theory. 

As  previously  stated,  the  fifty-year  record  of  Massachusetts 
affords  the  very  best  available  standard  of  measurement  and 


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29 

comparison  for  any  study  of  infant  mortality  in  this  country, 
and  in  comparison  with  that  standard  the  reports  of  recent 
decennial  censuses  of  the  United  States,  at  best  dealing  with 
single  twelvemonths  -ten  years  apart,  are  of  but  little  value. 
In  his  interesting  paper  issued  under  the  title  of  "A  Discussion 
of  the  Vital  Statistics  of  the  Twelfth  Census"  by  the  Bureau 
of  the  Census  in  1904  (Bulletin  15),  Dr.  Billings  thus  clearly 
explains  this  fact  (pp.  7-8):  "If  the  purpose  in  consulting 
these  reports  be  to  obtain  comparative  data  showing  the 
result  of  varying  conditions  upon  the  general  mortality,  or  to 
show  the  relative  death-rates  at  different  ages,  from  different 
causes  or  of  different  classes  of  population  in  the  same  or  differ- 
ent places  during  a  series  of  consecutive  years,  the  informa- 
tion must  be  sought  from  the  local  reports  on  this  subject 
issued  by  the  States  or  cities  for  which  comparisons  are  wanted. 
Here  the  student  or  analyst  finds  great  difficulty  in  securing 
any  comprehensive  information,  owing  to  lack  of  tables  cover- 
ing the  details  sought.  Very  few  of  the  cities  make  any  exten- 
sive compilation  of  the  material  at  their  command,  and  in  such 
compilations  which  are  most  complete,  as  well  as  in  the  State 
reports,  there  are  differences  in  the  forms  of  tables  and  in  the 
methods  of  classifying  the  data  which  prevent  carrying  com- 
parisons very  far,  even  if  they  do  not  entirely  preclude  them. 
.  .  .  No  State  has  a  complete  registration  of  births,  the  ones 
that  come  nearest  to  it  being  probably  Massachusetts,  Rhode 
Island,  and  Connecticut,  but  the  results  of  the  registration 
in  these  States  should  be  sought,  not  in  the  census  report,  but 
in  the  State  reports  of  births,  marriages,  and  deaths.  The 
only  States  which  had  (at  the  time  the  Twelfth  Census  was 
taken)  a  registration  of  deaths  sufficiently  complete  to  make 
the  death-rates  worth  calculating  were  Connecticut,  Maine, 
Massachusetts,  Michigan,  New  Hampshire,  New  Jersey,  New 
York,  and  Rhode  Island,  which  with  the  District  of  Columbia 
(and  Vermont)  form  the  group  referred  to  in  the  census  report 
as  the  'registration'  States." 

Having  secured  by  the  courtesy  of  the  registration  officials 
of  all  the  registration  States  copies  of  their  recent  reports,  and 


30 

carefully  studied  them  with  a  view  to  the  compilation,  if  pos- 
sible, of  a  general  resume  of  the  infant  death-rates  in  those 
States  for  a  period  of  sufficient  length  to  warrant  at  least  cer- 
tain general  deductions,  the  writer  is  more  than  ready  to  agree 
with  Dr.  Billings  that  "  in  the  State  reports  [of  vital  statistics] 
there  are  differences  in  the  forms  of  tables  and  in  the  methods 
of  classifying  the  data  which  prevent  carrying  comparisons 
very  far,  even  if  they  do  not  entirely  preclude  them." 

The  Massachusetts  report  affords  by  far  the  best  data  for 
that  purpose,  containing  a  compact  tabulation  of  infant  mor- 
tality and  the  rate  per  100  living  births  for  each  of  the  last 
twenty  years.  But  no  such  thoroughly  welcome  data  are  to 
be  found  in  any  of  the  other  registration  States'  current  re- 
ports. The  Connecticut  report,  which  probably  ranks  second 
in  general  utility,  has  a  ten-year  table  of  mortality  and  death- 
rates  by  ages,  but  the  death-rates  for  children  under  1  year 
are  the  percentage  ratios  to  total  mortality.  The  New  Jersey 
report's  data  and  diagram  dealing  with  infant  mortality  are 
made  up  on  a  basis  of  deaths  under  5  years.  The  Rhode 
Island  report  states  the  annual  infant  death-rates  to  births 
for  the  last  five  years,  but  presents  the  rates  for  the  previous 
fifty  years  in  the  abbreviated  form  of  three  ten-year  and  one 
twenty-year  ratios.  Most,  if  not  all,  of  the  other  registration 
reports  are  even  less  serviceable  in  any  extended  compilation 
of  infant  mortality,  in  some  cases  still-births  having  been  in- 
cluded in  the  figures  up  to  very  recent  dates ;  and  after  a  study 
of  them  all  it  became  apparent  that  the  United  States  census 
reports  afford  the  only  practicable  means  of  securing  within 
any  reasonable  time  a  comparative  showing  of  the  infant  mor- 
tality in  even  the  registration  States  for  any  considerable 
stretch  of  time,  that  is  to  say,  with  all  the  figures  compiled 
and  tabulated  on  a  common  basis.  For  reasons  already  stated 
an  attempt  to  tabulate  the  returns  from  the  country  at  large, 
including  the  non-registration  States,  would  have  been  un- 
worthy of  serious  consideration. 

In  the  introductory  remarks  to  his  analysis  of  the  vital  sta- 


31 

tistics  of  the  Twelfth  Census,  the  late  William  A.  King  noted 
(vol.  iii;  p.  xii)  that  "the  census  utilization  of  registration 
records  as  a  source  of  information  commenced  with  the  Tenth 
Census  (1880),  when  copies  of  the  records  of  two  States,  Mas- 
sachusetts and  New  Jersey,  were  secured  and  used  as  the  basis 
of  the  statistics  for  those  States.  At  the  Eleventh  Census 
(1890)  the  registration  area  was  extended  to  include  seven 
other  States,  namely:  Connecticut,  Rhode  Island,  New  Hamp- 
shire, Vermont,  New  York,  Delaware,  and  the  District  of  Co- 
lumbia, with  the  cities  therein  and  83  cities  in  other  States." 
As  stated  in  the  introduction  to  the  inaugural  volume  of  the 
present  annual  mortality  statistics,  issued  in  1906  by  the 
Bureau  of  the  Census  (p.  xiv),  when  the  Twelfth  Census  was 
taken  the  registration  area  included  all  of  the  last-named 
States,  and  in  addition  the  States  of  Maine  and  Michigan,  and 
153  cities  of  8,000  or  more  population  in  other  States. 

The  census  utilization  of  registration  records  not  having 
commenced  until  the  taking  of  the  Tenth  Census,  in  1880, 
any  inquiry  regarding  infant  mortality  in  this  country  as 
recorded  in  the  census  reports  is  obviously  restricted  to  the 
Tenth  Census  for  the  earliest  records  of  any  value  whatsoever, 
and  the  tables  which  have  been  prepared  for  this  paper  are 
therefore  confined  to  the  records  of  the  Tenth,  Eleventh,  and 
Twelfth  Censuses.  Although  Massachusetts  and  New  Jersey 
were  the  only  States  whose  registration  records  were  used  in 
the  compilation  of  the  Tenth  Census,  most,  if  not  all,  of  the 
other  registration  States  of  1900  had  established  bureaus  of 
vital  statistics  as  early  as  1880.  All  of  them  except  Maine  and 
Michigan  were  included  among  the  registration  States  when 
the  Eleventh  Census  was  taken,  and,  in  order  to  make  the  com- 
parison complete  for  the  three  latest  censuses,  the  figures  for 
both  1880  and  1890  of  all  the  registration  States  of  1900 
are  included  in  the  following  tables.  Prior  to  the  Twelfth 
Census,  still-births,  which  were  then  excluded,  had  been  in- 
cluded in  the  United  States  census  mortality  figures,  but  in  all 
of  the  tables  here  presented  the  still-births  for  all  three  census 
years  have  been  eliminated. 


32 


In  the  second  annual  report  of  the  Registrar-General's  office, 
*  issued  in  1840,  in  his  discussion  of  the  mortality  of  children, 
Dr.  Farr  laid  down  the  rule  (p.  16)  that,  "even  though  the 
registration  of  births  is  still  deficient,  yet,  even  with  this  ad- 
mitted probable  deficiency,  the  number  of  births,  if  applied  as 
an  element  of  calculation,  will  show  a  mortality  much  less  than 
it  appears  in  the  Comparative  Table  of  Deaths,"  and  from  that 
day  to  this  that  method  of  calculating  the  infant  mortality  rate 
has  practically  been  regarded  by  all  statistical  authorities  on  the 
subject  as  freest  from  error,  and  hence  the  most  reliable  of  all 
known  methods  of  measuring  the  rate.  By  applying  this  stand- 
ard of  measurement  the  deaths  under  1  year  and  rates  per  1,000 
births  in  1880, 1890,  and  1900  in  the  registration  States  of  1900, 
have  been  as  shown  in  the  appended  table,  according  to  the 
United  States  census  reports  for  the  years  in  question. 

Many  and  serious  as  the  defects  in  this  table  are — especially 
for  the  earliest  year,  1880,  when  Massachusetts  and  New  Jersey 
were  the  only  registration  States — it  probably  provides  at 

TABLE   IX. 
BIRTHS,  DEATHS  UNDER  1,  AND  DEATH-RATES  PER  1,000  BIRTHS  IN  EACH  OP  THE  REGISTRATION  STATES 

OF    1900,    ACCORDING   TO    THE    TENTH,    ELEVENTH,     AND     TWELFTH     CENSUS     REPORTS STILL-BIRTHS 

EXCLUDED    IN    EACH    CASE. 


States. 

Census  Year  1900. 

Census  Year  1890. 

Census  Year  1880. 

Births 
during 
Census 
Year. 

Deaths 
under 
1  Year 
of  Age. 

Deaths 
under  1 
per 
1,000 
Births. 

Births 
during 
Census 
Year. 

Deaths 
under 
1  Year 
of  Age. 

Deaths 
under  1 
per 
1,000 
Births. 

Births 
during 
Census 
Year. 

Deaths 
under 
1  Year 
of  Age. 

Deaths 
under  1 
per 
1,000 
Births. 

Registration   States   of 
1900    

418,321 

60,524 

144.7 

329,823 

53,645 

162.6 

297,490 

36,036 

121.1 

Connecticut    

21,757 
5,612 
14,716 
67,228 
58,800 
8,872 
48,158 
175,334 
10,472 
7,372 

3,101 
1,306 
1,946 
10,754 
6,570 
1,384 
7,292 
25,492 
1,854 
825 

142.5 
232.7 
132.2 
160.0 
111.7 
156.0 
151.4 
145.4 
177.0 
111.9 

15,864 
5,314 
11,761 
48,156 
51,931 
6,918 
36,351 
139,642 
7,732 
6,154 

2,344 
1,382 
1,124 
8,792 
4,667 
1,063 
6,939 
25,208 
1,490 
636 

147.8 
260.1 
95.6 
182.6 
89.9 
153.7 
190.9 
180.5 
192.7 
103.3 

13,825 
*  5,454 
13,447 
41.338 
45,244 
6,557 
31,069 
126,740 
6,603 
7,213 

1,387 
*  1,283 
912 
5,891 
3,744 
589 
4,296 
16,632 
711 
591 

100.3 
*  235.2 
67.8 
142.5 
82.7 
89.8 
138.3 
131.2 
107.7 
81.9 

District  of  Columbia    . 
Maine      

Massachusetts    .... 
Michigan     

New  Hampshire    .    .    . 
New  Jersey    
New  York              .    .    . 

Rhode  Island     .... 
Vermont     

*  Including  still-births,  no  returns  for  still-births  being  given  in  reports  of  Tenth  Census. 


33 

least  an  approximate  idea  of  the  relative  death-rates  among 
children  under  1  year  of  age  in  the  States  in  question  in  the 
census  years  1880,  1890,  and  1900.  The  District  of  Columbia 
has  been  included  solely  for  the  reason  that  it  was  part  and 
parcel  of  the  registration  area  in  1900,  but  its  death-rate  is  not 
to  be  seriously  considered,  including  as  it  does  the  heavy  mortal- 
ity among  colored  children,  the  colored  infant  death-rate  being 
nearly  twice  as  high  as  the  white  rate  in  each  case.  As  the 
District  of  Columbia  was  the  only  portion  of  the  registration 
area  in  1900  having  any  considerable  percentage  of  colored 
population,  and  as  the  comparatively  unimportant  colored  mor- 
tality in  the  registration  States  is  a  negligible  quantity  so  far 
as  affecting  the  general  mortality  rates  is  concerned,  it  was  not 
deemed  advisable  to  attempt  to  separate  the  white  and  colored 
mortality  in  the  preparation  of  the  tables  in  this  paper  based 
upon  the  census  reports.  The  District  of  Columbia  figures 
are,  therefore,  of  practically  no  importance  in  this  analysis  of 
the  statistics  of  infant  mortality,  and  may  properly  be  disre- 
garded in  the  study  of  any  of  the  tables  in  which  they  appear. 
With  them  eliminated,  it  will  be  noted  that  in  1880  Massachu- 
setts apparently  led  all  the  States  named  in  its  apparent  infant 
death-rate  of  142.5,  but  that  Rhode  Island  took  the  lead  in  1890 
and  retained  it  in  1900.  According  to  the  census  reports, 
Massachusetts'  infant  death-rates  in  the  census  years  1880, 
1890,  and  1900,  were  respectively  142.5,  182.6,  and  160.0  as 
compared  with  rates  of  162.6,  166.6,  and  156.7  for  the  calendar 
years  in  question,  according  to  the  registration  records  of  the 
State  as  presented  in  Table  VI. 

The  above  table  undoubtedly  presents  the  most  accurate 
showing  of  infant  mortality  in  the  districts  dealt  with  which 
can  be  compiled  from  the  census  reports  for  the  years  in  ques- 
tion, but,  in  order  to  perfect  the  statistical  record  of  the  subject, 
it  may  be  worth  while  to  find  space  for  the  infant  death-rates  in 
the  several  States  named,  as  measured,  (1)  by  the  rate  of  deaths 
under  1  year  per  1,000  of  the  supposed  living  population  of 
that  age,  and  (2)  by  the  ratio  of  infant  deaths  to  total  deaths. 
The  census  figures  in  both  cases  are  presented  in  Tables  X  and 
XI  herewith  appended : — 


TABLE  X. 

THE  INFANT  MORTALITY  RATE  IN  1880,  1890,  AND  1900  IN  EACH  OP  THE  REGISTRATION  STATES  OF  1900. 
AS  MEASURED  BY  THE  RATE  OF  DEATHS  UNDER  1  YEAR  PER  1,000  LIVING  POPULATION  OF  THAT  AGE, 

ACCORDING    TO    THE    TENTH,    ELEVENTH,    AND    TWELFTH    CENSUS     REPORT STILL-BIRTHS    EXCLUDED. 


States. 

Census  Year  1900. 

Census  Year  1890. 

Census  Year  1880. 

Popula- 
tion at 
End  of 
Census 
Year. 

Deaths. 

Death- 
rate 
per 
1,000 
Living. 

Popula- 
tion at 
End  of 
Census 
Year. 

Deaths. 

Death- 
rate 
per 
1,000 
Living. 

Popula- 
tion at 
End  of 
Census 
Year. 

Deaths. 

Death- 
rate 
per 
1,000 
Living. 

Registration    States    of 
1900                    .    .    . 

379,951 

60,524 

159.3 

298,154 

53,645 

179.9 

273,559 

36,036 

131.7 

19,774 
4,758 
13,503 
60,492 
54,161 
8,048 
43,571 
159,521 
9,368 
6,755 

3,101 
1,306 
1,946 
10,754 
6,570 
1,384 
7,292 
25,492 
1,854 
825 

156.8 
274.5 
144.1 
177.8 
121.3 
172.0 
167.3 
159.8 
197.9 
122.1 

14,469 
4,467 
11,158 
43,043 
48,954 
6,347 
32,087 
124,977 
6,890 
5,762 

2,344 
1,382 
1,124 
8,792 
4,667 
1,063 
6,939 
25,208 
1,490 
636 

162.0 
309.4 
100.7 
204.3 
95.3 
167.5 
216.2 
201.7 
216.3 
110.4 

12,879 
4,624 
12,812 
37,587 
42,585 
6,141 
28,192 
115,847 
6,132 
6,760 

1,387 
*1,283 
912 
5,891 
3,744 
589 
4,296 
16,632 
711 
591 

107.7 
*277.5 
71.2 
156.7 
87.9 
95.9 
152.4 
143.6 
115.9 
87.4 

District  of  Columbia    . 

Massachusetts   .... 
Michigan    

New  Hampshire    .    .    . 
New  Jersey    

New  York  

Rhode  Island     .... 

*  Including  still-births,  no  returns  for  still-births  being  given  in  reports  of  Tenth  Census. 

TABLE   XL 

THE  INFANT  MORTALITY  RATE  IN  1880,  1890,  AND  1900  IN  EACH  OF  THE  REGISTRATION  STATES  OF  1900, 
AS  MEASURED  BY  THE  RATE  OF  DEATHS  UNDER  1  YEAR  PER  1,000  DEATHS  AT  ALL  AGES,  ACCORDING 
TO  THE  TENTH,  ELEVENTH,  AND  TWELFTH  CENSUS  REPORTS — STILL-BIRTHS  EXCLUDED. 


States. 

Census  Year  1900. 

Census  Year  1890. 

Census  Year  1880. 

Total 
Deaths 
during 
Census 
Year. 

Deaths  under 
Age  1  during 
Census  Year. 

Total 
Deaths 
during 
Census 
Year. 

Deaths  under 
Age  1  during 
Census  Year. 

Total 
Deaths 
during 
Census 
Year. 

Deaths  under 
Age  1  during 
Census  Year. 

Deaths. 

Rate 
per 
1,000 
at  All 
Ages. 

Deaths. 

Rate 
per 
1,000 
at  All 
Ages. 

Deaths. 

Rate 
per 
1,000 
at  All 

Ages. 

Registration  States  of 
1900    

301,670 

60,524 

200.6 

262,149 

53,645 

204.6 

191,230 

36,036 

188.4 

Connecticut   

15,422 
6,364 
12,148 
49,756 
33,572 
7,400 
32,735 
130,268 
8,176 
5,829 

3,101 
1,306 
1,946 
10,754 
6,570 
1,384 
7.292 
25,492 
1,854 
825 

201.1 
205.2 
160.2 
216.1 
195.7 
187.0 
222.7 
195.7 
226.8 
141.5 

13,863 
5,449 
9,974 
43.102 
24,118 
6,856 
28,455 
117,837 
7,234 
5,261 

2,344 
1,382 
1,124 
8,792 
4,667 
1,063 
6,939 
25,208 
1,490 
636 

169.1 
253.6 
112.7 
204.0 
193.5 
155.0 
243.8 
213.9 
206.0 
120.9 

8,977 
*4,192 
9,384 
31,752 
19,144 
5,503 
18,434 
84,450 
4,507 
4,887 

1,387 
*1,283 
912 
5,891 
3,744 
589 
4,296 
16.632 
711 
591 

154.5 
*306.1 
97.2 
185.5 
195.6 
107.0 
233.0 
196.9 
157.7 
120.9 

District  of  Columbia    . 
Maine      

Massachusetts    .... 
Michigan 

New  Hampshire    .    .    . 
New  Jersey    

New  York  

Rhode  Island     .... 
Vermont 

*  Including  still-births,  no  returns  for  still-births  being  given  in  reports  of  Tenth  Census. 


35 

Were  the  tabulation  of  the  census  records  of  the  infant  death- 
rate  per  1,000  of  living  population  under  1  year  at  the  end  of 
each  census  year  unaccompanied  by  tables  based  on  other  stand- 
ards of  measuring  infant  mortality,  affording  ready  means  of 
checking  the  various  figures  and  thus  measuring  the  probable 
margin  of  error,  it  would  be  comparatively  valueless.  For,  as 
previously  stated,  the  census  authorities  have  often  admitted 
that  the  data  regarding  the  number  of  living  children  under  1 
year  of  age  are  utterly  incomplete  and  inaccurate.  As  Dr. 
Farr  put  it  in  discussing  the  mortality  of  infants  (Supplement 
to  25th  Annual  Report  of  the  Registrar-General,  pp.  v-vi),  "The 
infants  in  the  first  year  of  life  are  to  some  extent  mixed  up  with 
infants  in  the  second  year  of  age."  And,  as  Dr.  Billings  ex- 
plained in  his  remarks  regarding  infantile  mortality  published 
in  the  Report  on  Vital  and  Social  Statistics  in  the  United  States 
at  the  Eleventh  Census  (Part  I,  p.  21):  "Unfortunately,  these 
data  are  incomplete  and  inaccurate,  not  only  for  the  United 
States  as  a  whole,  but  for  all  parts  of  the  registration  area.  This 
is  due  to  the  fact  that  the  number  of  children  returned  as  being 
under  1  year  of  age  is  too  small  in  every  locality,  owing  partly 
to  omissions  in  the  enumeration,  and  partly  to  the  tendency  of 
those  reporting  the  age  of  infants  to  report  those  who  are  be- 
tween 9  and  12  months  of  age  as  being,  in  round  numbers,  1 
year  old,  which  last  is  a  defect  common  to  the  censuses  of  all 
countries." 

The  apparent  living  population  under  1  year  of  age  for  these 
reasons  being  much  understated  in  the  returns,  of  course  the 
alleged  rates  of  deaths  under  1  to  the  living  population  at  that 
age  are  almost  invariably  in  excess  of  the  actual  rates  on  that 
basis:  hence  the  table  worked  out  on  those  lines  would  be  of 
little  value  by  itself.  The  tabulation  of  rates  of  infant  deaths 
per  1,000  deaths  at  all  ages  probably  is  open  to  less  objection, 
but  that  table,  too,  is  open  to  much  more  intelligent  interpre- 
tation when  supplemented  with  tables  prepared  on  other  bases 
of  measurement,  and  especially  with  one  laid  out  on  the  gener- 
ally accepted  plan  of  death-rates  to  births.  But  for  the  presence 
of  the  last-named  table,  it  would  not  have  been  considered 


36 


worth  while  to  present  in  this  article  the  two  other  tables  above 
mentioned. 

The  death-rate  of  persons  over  1  year  of  age  is  a  natural  com- 
plement to  the  death-rate  of  infants  under  1  year,  if  both  are 
prepared  on  a  common  basis,  and  materially  aids  in  deter- 
mining whether  a  high  infant  mortality  is  presumably,  in  part 
at  least,  due  to  unsanitary  conditions  or  to  independent  causes. 
In  none  of  the  works  on  the  subject  of  infantile  mortality  which 
the  writer  has  examined  does  such  a  tabulation  appear,  and  by 
way  of  adding  at  least  some  information  to  the  statistical  rec- 
ords of  the  subject  the  following  table  has  been  prepared,  on 
the  basis  of  the  census  reports  for  1880,  1890,  and  1900:— 


TABLE   XII. 

DEATHS  over  1  YEAR  OP  AGE  AND  RATE  PER  1,000  POPULATION  OVER  1  YEAR  IN  1880,  1890,  AND  1900 
IN  THE  REGISTRATION  STATES  OF  1900,  ACCORDING  TO  THE  TENTH,  ELEVENTH,  AND  TWELFTH  CENSUS 
REPORTS. 


• 

Census  Year  1900. 

Census  Year  1890. 

Census  Year  1880. 

ill 

slsi 

M 

i 

sis 

M 

L| 

1-1  i   . 

u,  3  J3 
^8 

C  a) 
&| 

States. 

0^6 
c^ 

°a^ 

•i 

||S 

o  §/* 

|i 

||g 

•1 

o 

03       x 

s  °  § 

%* 

o 
go's 

3*1 

.2    «*. 

m'o  g 

68^ 

J  ° 

Ilil 

lit 

Is 

3  >-      t-' 

fill 

II? 

Is 

Ilil 

1i« 

II 

Registration   States 

of  1900     .... 

17,064,329 

241,146 

14.1 

14,169,658 

208,504 

14.7 

11,765,518 

155,194 

13.2 

Connecticut     .    .    . 

888,646 

12,321 

13.9 

731,789 

11,519 

15.7 

609,821 

7,590 

12.4 

District  of  Columbia, 

273,960 

5,058 

18.5 

225,925 

4,067 

18.0 

173,000 

2,909 

16.8 

Maine 

680  963 

10  202 

15.0 

649,928 

8,850 

13.6 

636,124 

8,472 

13.3 

Massachusetts     .    . 

2,744,854 

39,002 

14.2 

2,195,900 

34,310 

15.6 

1,745,498 

25,861 

14.8 

Michigan 

2  366  821 

27,002 

11.4 

2,044,935 

19,451 

9.5 

1,594,352 

15,400 

9.7 

New  Hampshire 

403,540 

6,016 

14.9 

370,183 

5,793 

15.6 

340,850 

4,914 

14.4 

New  Jersey  .... 

1,840,098 

25,443 

13.8 

1,412,846 

21,516 

15.2 

1,102,924 

14,138 

12.8 

New  York   .... 

7,109,373 

104,776 

14.7 

5,872,876 

92,629 

15.8 

4,967,024 

67,818 

13.7 

Rhode  Island  .    .    . 

419,188 

6,322 

15.1 

338,616 

5,744 

17.0 

270,399 

3,796 

14.0 

Vermont       .... 

336,886 

5,004 

14.9 

326,660 

4,625 

14.2 

325,526 

4,296 

13.2 

3T 


In  so  far  as  the  mortality  reports  of  the  Tenth,  Eleventh, 
and  Twelfth  Censuses  contribute  any  really  material  data  to  the 
records  of  infant  mortality  in  the  last  three  census  years  in  the 
States  recognized  as  registration  States  in  1900,  the  preceding 
table  practically  rounds  out  the  information  therein  obtainable, 
and  it  might  now  seem  to  be  in  order  to  make  a  comparison  of 
the  infant  death-rates  in  the  several  registration  States  as 
measured  by  the  standards  of  the  various  tables  which  have 
been  presented.  By  so  doing,  at  least  an  approximate  idea  of 
the  actual  relative  rank  of  the  States  in  question  in  point  of 
their  respective  infant  death-rates  may  be  obtained,  and,  pos- 
sibly, some  information  of  working  value  be  contributed  to 
the  rapidly  growing  bibliography  of  the  subject.  Perhaps  the 
shortest  and  most  effective  means  of  reaching  this  end  will  be 
that  of  assembling  at  close  contact  the  infant  death-rates  of  each 
State  according  to  the  various  standards  of  calculation  em- 
ployed in  the  preceding  tables,  and  attaching  in  each  case  the 
numeral  showing  the  relative  rank  of  the  State  in  question 
from  that  point  of  view.  In  compact  form  here  are  the  results 
of  an  inquiry  shaped  on  those  lines,  eliminating  the  District  of 
Columbia  for  reasons  previously  explained: — 

TABLE  XIII. 

A  COMPARISON  OP  THE  INFANT  MORTALITY  RATES — AND  THEIR  COMPLEMENT,  THE  DEATH-RATE  AT  ALL 
AGES  over  1  YEAR — IN  1900,  1890,  AND  1880  IN  THE  REGISTRATION  STATES  OF  1900,  AND  THE  RELA- 
TIVE RANK  OF  EACH  OF  THE  NINE  STATES  IN  THE  ORDER  OF  THOSE  DEATH-RATES. 


Death-rate  under  1  Year  per  1,000 
Births. 

Death-rate  under  1  Year  per  1,000  of 
that  Age  living  at  End  of  Census  Year. 

States. 

1900. 

1890. 

1880. 

1900. 

1890. 

1880. 

Rate. 

Rank. 

Rate. 

Rank. 

Rate. 

Rank. 

Rate. 

Rank. 

Rate. 

Rank. 

Rate. 

Rank. 

Connecticut    .    .    . 

142.5 

6 

147.8 

6 

100.3 

5 

156.8 

6 

162.0 

6 

107.7 

5 

Maine  

132.2 

7 

95.6 

8 

67.8 

9 

144.1 

7 

100.7 

8 

71.2 

9 

Massachusetts    . 

160.0 

2 

182.6 

3 

142.5 

1 

177.8 

2 

204.3 

3 

156.7 

1 

Michigan     .    .    . 

111.7 

9 

89.9 

9 

82.7 

7 

121.3 

9 

95.3 

9 

87.9 

7 

New  Hampshire 

156.0 

3 

153.7 

5 

89.8 

6 

172.0 

3 

167.5 

5 

95.9 

6 

New  Jersey     .    . 

151.4 

4 

190.9 

2 

138.3 

2 

167.3 

4 

216.2 

2 

152.4 

2 

New  York  .    .    . 

145.4 

5 

180.5 

4 

131.2 

3 

159.8 

5 

201.7 

4 

143.6 

3 

Rhode  Island     . 

177.0 

1 

192.7 

1 

107.7 

4 

197.9 

1 

216.3 

1 

115.9 

4 

Vermont     .    .    . 

111.9 

8 

103.3 

7 

81.9 

8 

122.1 

8 

110.4 

7 

87.4 

8 

38 


TABLE  XIII—  Continued. 


Death-rate  under  1  Year  per  1,000 
Deaths  at  All  Ages. 

Death-rate  for  All  Ages  over  1  Year  per  1  ,000 
of  Those  Ages  Laving  at  End  of  Census  Year. 

States. 

1900. 

1890. 

1880. 

1900. 

1890. 

1880. 

Rate. 

Rank. 

Rate. 

Rank. 

Rate. 

Rank. 

Rate. 

Rank. 

Rate. 

Rank. 

Rate. 

Rank. 

Connecticut    .    .    . 

201.1 

4 

169.1 

6 

154.5 

6 

13.9 

7 

15.7 

3 

12.4 

8 

Maine  

160.2 

8 

112.7 

9 

97.2 

9 

15.0 

2 

13.6 

8 

13.3 

5 

Massachusetts 

216.1 

3 

204.0 

4 

185.5 

4 

14.2 

6 

15.6 

4— 

14.8 

1 

Michigan     .    . 

195.7 

5— 

193.5 

5 

195.6 

3 

11.4 

9 

9.5 

9 

9.7 

9 

New  Hampshire 

187.0 

7 

155.0 

7 

107.0 

8 

14.9 

3— 

15.6 

4— 

14.4 

2 

New  Jersey     . 

222.7 

2 

243.8 

1 

233.0 

1 

13.8 

8 

15.2 

6 

12.8 

7 

New  York       . 

195.7 

5— 

213.9 

2 

196.9 

2 

14.7 

5 

15.8 

2 

13.7 

4 

Rhode  Island 

226.8 

1 

206.0 

3 

157.7 

5 

15.1 

1 

17.0 

1 

14.0 

3 

Vermont     .    . 

141.5 

9 

120.9 

8 

120.9 

7 

14.9 

3— 

14.2 

7 

13.2 

6 

A  somewhat  noticeable  feature  of  this  tabulation  of  compari- 
sons is  the  fact  that,  materially  differing  though  the  infant 
death-rates  of  any  particular  State  do  in  any  one  census  year 
as  measured  by  the  ratios  to  births  and  to  living  population  at 
the  age  of  1  at  the  end  of  the  census  year,  in  every  case  the 
relative  rank  of  the  State  as  determined  by  the  two  standards 
remains  the  same  in  all  three  census  years.  For  instance, 
Massachusetts  ranked  first  in  1880,  third  in  1890,  and  second 
in  1900  in  point  of  both  death-rates  to  births  and  to  living 
population  under  age  1  at  the  end  of  the  census  year;  New 
Jersey  ranked  second  in  both  1880  and  1890,  and  fourth  in 
1900,  by  both  measurements,  and  so  on.  In  a  general  way,  it 
might  be  expected  that  there  probably  would  be  no  radical 
shift  in  the  ranking  of  the  States  from  census  to  census  in  point 
of  either  the  number  of  births  or  the  population  under  age  1 
at  the  end  of  the  census  years,  but  the  coincidence  of  each 
State's  ranking  remaining  the  same  in  any  census  year,  whether 
measured  by  the  rate  of  infant  deaths  to  births  or  to  surviving 
infants  under  age  1  at  the  end  of  the  census  year,  is  at  least 
passing  strange,  taking  into  account  the  habitual  and  historic 
inaccuracy  in  the  reporting  of  living  infants  under  age  1. 

Of  course,  if  the  infant  migration  and  emigration  in  a  census 


39 

year  were  disregarded,  if  the  infant  deaths  during  the  census 
year  were  restricted  to  babies  born  during  the  year,  and  if 
census  returns  were  complete  and  absolutely  accurate,  the 
number  living  under  age  1  at  the  end  of  the  year  would  be  the 
exact  complement  of  the  number  dying  during  the  year.  But  the 
infant  migration  and  emigration  cannot  be  disregarded.  A 
minor  but  considerable  percentage  of  the  infant  deaths  in  any 
year  are  those  of  babies  born  in  the  later  months  of  the  previous 
year;  and  the  returns  for  births,  deaths,  and  living  population 
by  ages — especially  for  population  under  age  1 — are,  and 
always  have  been,  notoriously  incomplete  and  inaccurate. 
Hence  the  absolute  uniformity  of  the  ranking  of  each  State 
in  the  last  three  censuses,  whether  measured  by  its  infant 
mortality  rate  to  births  or  to  living  population  under  age  1, 
is  at  least  worthy  of  note. 

Unfortunately,  the  figures  of  most  of  the  registration  States, 
so  far  as  the  infant  death-rate  to  births  is  concerned,  have  been 
open  to  the  suspicion  of  too  glaring  inaccuracies — at  least  up  to 
a  very  recent  period — to  warrant  any  attempt  to  make  com- 
parison between  them  and  those  of  the  European  countries  with 
long-established  registration  systems.  But  the  census  returns 
for  these  States  in  1880,  1890,  and  1900,  herewith  presented 
for  what  they  are  worth,  are  none  the  less  worthy  of  a  careful 
study  from  various  view-points  by  those  interested  in  the  subject 
of  infant  mortality. 

In  this  paper  the  writer  has  aimed  to  supplement  the  work 
of  the  numerous  medical  experts,  who  have  long  been  probing 
the  puzzling  problems  of  infant  mortality,  by  bringing  to- 
gether from  various  sources  and  presenting  in  compact  form 
the  most  reliable  statistical  information  now  obtainable  which 
would  warrant  some  definite  conclusions  as  to  the  rise  or  fall 
of  the  infant  mortality  rate  in  recent  years  throughout  the 
world,  and  the  apparent  present  tendencies  of  the  infant  death- 
rate.  It  has  seemed  possible  that  the  presentation  of  specific 
information  on  these  lines  might  provide  sound  foundations, 
in  the  way  of  authoritative  facts  and  figures  of  international 
scope,  for  the  widely  extended  movement  now  being  earnestly 


40 

made  for  the  reduction  of  the  infant  death-rate.  If  so,  the 
purpose  of  this  paper  will  have  been  served,  and  possibly  in 
a  later  paper  the  writer  may  present  some  of  the  mass  of  data 
as  to  the  fundamental  causes  for  the  abnormally  heavy  infant 
mortality  in  certain  sections — and  especially  in  certain  factory 
towns — which  have  accumulated  in  his  hands,  but  have  been 
foreign  to  the  purposes  of  this  preliminary  and  purely  statis- 
tical study  of  the  far-reaching  subject  which  is  just  beginning 
in  these  twentieth-century  days  to  make  its  real  importance 
felt.  In  the  consideration  of  it,  and  of  the  almost  innumerable 
problems  involved  in  it,  not  only  the  prospective  population, 
but  the  general  welfare,  of  the  entire  civilized  world  are  deeply 
concerned.  As  Dr.  Alden  has  so  gravely  remarked,  "A  thor- 
ough understanding  of  the  subject  should  be  the  concern  of 
every  true  citizen." 


